Adeno-associated virus vector delivery of b-sarcoglycan and microrna-29 and the treatment of muscular dystrophy

ABSTRACT

Described herein are recombinant AAV vectors comprising a polynucleotide sequence comprising β-sarcoglycan and methods of using the recombinant vectors to reduce or prevent fibrosis in a mammalian subject suffering from a muscular dystrophy. Also described herein are combination therapies comprising administering AAV vector(s) expressing β-sarcoglycan and miR-29c to a mammalian subject suffering from a muscular dystrophy.

This application claims priority benefit of U.S. Provisional ApplicationNo. 62/323,333 filed Apr. 15, 2016 and U.S. Provisional Application No.62/433,548, filed Dec. 13, 2016, both of which are incorporated byreference herein in its entirety.

INCORPORATION BY REFERENCE OF MATERIAL SUBMITTED ELECTRONICALLY

This application contains, as a separate part of the disclosure, aSequence Listing in computer-readable form which is incorporated byreference in its entirety and identified as follows: Filename:50622A_Seqlisting.txt; Size: 21,466 bytes, created: Apr. 13, 2017.

FIELD OF THE INVENTION

Described herein are therapy vectors such as AAV vectors expressingβ-sarcoglycan and method of using these vectors to reduce and preventfibrosis in subjects suffering from a muscular dystrophy. The inventionalso provides for combination gene therapy methods comprising theadministration of a first AAV vector expressing β-sarcoglycan and asecond AAV vector expressing miR-29 to reduce and prevent fibrosis inpatients suffering from muscular dystrophy.

BACKGROUND

Limb-girdle muscular dystrophy (LGMD) type 2E (LGMD2E) is an autosomalrecessive disorder resulting from mutations in the gene encodingβ-sarcoglycan (SGCB), causing loss of functional protein.1 LGMD2Erepresents a relatively common and severe form of LGMD in the UnitedStates with worldwide reports of incidence of 1/200,000-1/350,000.(2)The absence of β-sarcoglycan leads to a progressive dystrophy withchronic muscle fiber loss, inflammation, fat replacement and fibrosis,all resulting in deteriorating muscle strength and function. (3,4) As acomplex, the sarcoglycans (α-, β, γ-, δ-), ranging in size between 35and 50 kD,(5) are all transmembrane proteins that provide stability tothe sarcolemma offering protection from mechanical stress during muscleactivity.(3) Loss of 3-sarcoglycan in LGMD2E usually results in varyingdegrees of concomitant loss of other sarcoglycan proteins contributingto the fragility of the muscle membrane leading to loss of myofibers.1Although the range of clinical phenotype of LGMD2E varies, diagnosistypically occurs before age 10 and with loss of ambulation occurring bymid to late teens.1,6,7 Patients present with elevated serum creatinekinase (CK), proximal muscle weakness, difficulty arising from the floorand progressive loss of ambulation. Cardiac involvement occurs in asmany as fifty percent of cases

Adeno-associated virus (AAV) is a replication-deficient parvovirus, thesingle-stranded DNA genome of which is about 4.7 kb in length includingtwo 145 nucleotide inverted terminal repeat (ITRs). There are multipleserotypes of AAV. The nucleotide sequences of the genomes of the AAVserotypes are known. For example, the complete genome of AAV-1 isprovided in GenBank Accession No. NC_002077; the complete genome ofAAV-2 is provided in GenBank Accession No. NC_001401 and Srivastava etal., J. Virol., 45: 555-564 {1983); the complete genome of AAV-3 isprovided in GenBank Accession No. NC_1829; the complete genome of AAV-4is provided in GenBank Accession No. NC_001829; the AAV-5 genome isprovided in GenBank Accession No. AF085716; the complete genome of AAV-6is provided in GenBank Accession No. NC_00 1862; at least portions ofAAV-7 and AAV-8 genomes are provided in GenBank Accession Nos. AX753246and AX753249, respectively; the AAV-9 genome is provided in Gao et al.,J. Virol., 78: 6381-6388 (2004); the AAV-10 genome is provided in Mol.Ther., 13(1): 67-76 (2006); and the AAV-11 genome is provided inVirology, 330(2): 375-383 (2004). The sequence of the AAV rh.74 genomeis provided in see U.S. Pat. No. 9,434,928, incorporated herein byreference. Cis-acting sequences directing viral DNA replication (rep),encapsidation/packaging and host cell chromosome integration arecontained within the AAV ITRs. Three AAV promoters (named p5, p19, andp40 for their relative map locations) drive the expression of the twoAAV internal open reading frames encoding rep and cap genes. The two reppromoters (p5 and p19), coupled with the differential splicing of thesingle AAV intron (at nucleotides 2107 and 2227), result in theproduction of four rep proteins (rep 78, rep 68, rep 52, and rep 40)from the rep gene. Rep proteins possess multiple enzymatic propertiesthat are ultimately responsible for replicating the viral genome. Thecap gene is expressed from the p40 promoter and it encodes the threecapsid proteins VP1, VP2, and VP3. Alternative splicing andnon-consensus translational start sites are responsible for theproduction of the three related capsid proteins. A single consensuspolyadenylation site is located at map position 95 of the AAV genome.The life cycle and genetics of AAV are reviewed in Muzyczka, CurrentTopics in Microbiology and Immunology, 158: 97-129 (1992).

AAV possesses unique features that make it attractive as a vector fordelivering foreign DNA to cells, for example, in gene therapy. AAVinfection of cells in culture is noncytopathic, and natural infection ofhumans and other animals is silent and asymptomatic. Moreover, AAVinfects many mammalian cells allowing the possibility of targeting manydifferent tissues in vivo. Moreover, AAV transduces slowly dividing andnon-dividing cells, and can persist essentially for the lifetime ofthose cells as a transcriptionally active nuclear episome(extrachromosomal element). The AAV proviral genome is inserted ascloned DNA in plasmids, which makes construction of recombinant genomesfeasible. Furthermore, because the signals directing AAV replication andgenome encapsidation are contained within the ITRs of the AAV genome,some or all of the internal approximately 4.3 kb of the genome (encodingreplication and structural capsid proteins, rep-cap) may be replacedwith foreign DNA. To generate AAV vectors, the rep and cap proteins maybe provided in trans. Another significant feature of AAV is that it isan extremely stable and hearty virus. It easily withstands theconditions used to inactivate adenovirus (56° to 65° C. for severalhours), making cold preservation of AAV less critical. AAV may even belyophilized. Finally, AAV-infected cells are not resistant tosuperinfection.

Multiple studies have demonstrated long-term (>1.5 years) recombinantAAV-mediated protein expression in muscle. See, Clark et al., Hum GeneTher, 8: 659-669 (1997); Kessler et al., Proc Nat. Acad Sc. USA, 93:14082-14087 (1996); and Xiao et al., J Virol, 70: 8098-8108 (1996). Seealso, Chao et al., Mol Ther, 2:619-623 (2000) and Chao et al., Mol Ther,4:217-222 (2001). Moreover, because muscle is highly vascularized,recombinant AAV transduction has resulted in the appearance of transgeneproducts in the systemic circulation following intramuscular injectionas described in Herzog et al., Proc Natl Acad Sci USA, 94: 5804-5809(1997) and Murphy et al., Proc Natl Acad Sci USA, 94: 13921-13926(1997). Moreover, Lewis et al., J Virol, 76: 8769-8775 (2002)demonstrated that skeletal myofibers possess the necessary cellularfactors for correct antibody glycosylation, folding, and secretion,indicating that muscle is capable of stable expression of secretedprotein therapeutics.

An emerging form of therapy for LGMD2E is viral-mediated gene deliveryto restore wild-type protein to affected muscle resulting in restorationof muscle function. Considering that a subset of patients can developcardiomyopathy, (8, 9, 10, 13) this would have to be considered in thelong-term care of these patients. In previous reports, the Sgcb-nullmouse was well characterized. Araishi et al.3 developed theβ-sarcoglycan-deficient mouse with accompanying loss of all of thesarcoglycans as well as sarcospan, with at least minor preservation ofmerosin, the dystroglycans and dystrophin, reproducing the clinicalpicture seen in LGMD2E. The histological changes in this animal modelwere also a prototype for the clinical counterpart, including theprominence of skeletal muscle fibrosis.(14) Dressman et al. (25)injected the transverse abdominal muscle using rAAV2.CMV.SGCB.Expression persisted for 21 months and muscle fibers were protected fromrecurrent necrosis. The use of self-complementary AAV to enhancetransgene expression,16 a muscle-specific promoter to better targetskeletal muscle (20, 26) and the optimization of a human β-sarcoglycangene (hSGCB) has also been described.

Functional improvement in patients suffering from LGMD and othermuscular dystrophies require both gene restoration and reduction offibrosis. There is a need for methods of reducing fibrosis that may bepaired with gene restoration methods for more effective treatments ofLGMD and other muscular dystrophies.

SUMMARY

Described herein are gene therapy vectors, e.g. AAV, expressing theβ-sarcoglycan gene and methods of delivering β-sarcoglycan to the muscleto reduce and/or prevent fibrosis; and/or to increase muscular force,and/or to treat a β-sarcoglycanopathy in a mammalian subject sufferingfrom muscular dystrophy.

In addition, the invention provides for combination therapies andapproaches using gene therapy vectors to deliver β-sarcoglycan toaddress the gene defect observed in LGMD2E and gene therapy vectorsdelivering miR-29 to further suppress fibrosis.

In one aspect, described herein is a recombinant AAV vector comprising apolynucleotide sequence encoding β-sarcoglycan. In some embodiments, thepolynucleotide sequence encoding β-sarcoglycan comprises a sequence e.g.at least 65%, at least 70%, at least 75%, at least 80%, 81%, 82%, 83%,84%, 85%, 86%, 87%, 88%, or 89%, more typically 90%, 91%, 92%, 93%, 94%,95%, 96%, 97%, 98%, 99% or more identical to the nucleotide sequence setforth in SEQ ID NO: 1 and encodes protein that retains β-sarcoglycanactivity. In some embodiments, the polynucleotide sequence encodingβ-sarcoglycan comprises the nucleotide sequence set forth in SEQ IDNO: 1. In some embodiments, the polynucleotide sequence encodingβ-sarcoglycan consists the nucleotide sequence set forth in SEQ ID NO:1.

In another aspect, a recombinant AAV vector described herein comprises apolynucleotide sequence encoding β-sarcoglycan that is at least 65%, atleast 70%, at least 75%, at least 80%, 81%, 82%, 83%, 84%, 85%, 86%,87%, 88%, or 89%, more typically at least 90%, 91%, 92%, 93%, or 94% andeven more typically at least 95%, 96%, 97%, 98% or 99% sequence identityto the amino acid sequence of SEQ ID NO: 2, and the protein retainsβ-sarcoglycan activity.

In another aspect, described herein is a recombinant AAV vectorcomprising a polynucleotide sequence encoding functional β-sarcoglycanthat comprises a nucleotide sequence that hybridizes under stringentconditions to the nucleic acid sequence of SEQ ID NO: 1, or a complementthereof.

The term “stringent” is used to refer to conditions that are commonlyunderstood in the art as stringent. Hybridization stringency isprincipally determined by temperature, ionic strength, and theconcentration of denaturing agents such as formamide. Examples ofstringent conditions for hybridization and washing are 0.015 M sodiumchloride, 0.0015 M sodium citrate at 65-68° C. or 0.015 M sodiumchloride, 0.0015M sodium citrate, and 50% formamide at 42° C. SeeSambrook et al., Molecular Cloning: A Laboratory Manual, 2nd Ed., ColdSpring Harbor Laboratory, (Cold Spring Harbor, N.Y. 1989). Morestringent conditions (such as higher temperature, lower ionic strength,higher formamide, or other denaturing agent) may also be used, however,the rate of hybridization will be affected. In instances whereinhybridization of deoxyoligonucleotides is concerned, additionalexemplary stringent hybridization conditions include washing in 6×SSC0.05% sodium pyrophosphate at 37° C. (for 14-base oligos), 48° C. (for17-base oligos), 55° C. (for 20-base oligos), and 60° C. (for 23-baseoligos).

Other agents may be included in the hybridization and washing buffersfor the purpose of reducing non-specific and/or backgroundhybridization. Examples are 0.1% bovine serum albumin, 0.1%polyvinyl-pyrrolidone, 0.1% sodium pyrophosphate, 0.1% sodiumdodecylsulfate, NaDodSO4, (SDS), ficoll, Denhardt's solution, sonicatedsalmon sperm DNA (or other non-complementary DNA), and dextran sulfate,although other suitable agents can also be used. The concentration andtypes of these additives can be changed without substantially affectingthe stringency of the hybridization conditions. Hybridizationexperiments are usually carried out at pH 6.8-7.4, however, at typicalionic strength conditions, the rate of hybridization is nearlyindependent of pH. See Anderson et al., Nucleic Acid Hybridisation: APractical Approach, Ch. 4, IRL Press Limited (Oxford, England).Hybridization conditions can be adjusted by one skilled in the art inorder to accommodate these variables and allow DNAs of differentsequence relatedness to form hybrids.

In another aspect, the recombinant AAV vectors described herein may beoperably linked to a muscle-specific control element. For example themuscle-specific control element is human skeletal actin gene element,cardiac actin gene element, myocyte-specific enhancer binding factorMEF, muscle creatine kinase (MCK), tMCK (truncated MCK), myosin heavychain (MHC), MHCK7 (a hybrid version of MHC and MCK), C5-12 (syntheticpromoter), murine creatine kinase enhancer element, skeletal fast-twitchtroponin C gene element, slow-twitch cardiac troponin C gene element,the slow-twitch troponin I gene element, hypozia-inducible nuclearfactors, steroid-inducible element or glucocorticoid response element(GRE).

In some embodiments, the muscle-specific promoter is MHCK7 (SEQ ID NO:4). An exemplary rAAV described herein is pAAV.MHCK7.hSCGB whichcomprises the nucleotide sequence of SEQ ID NO: 3; wherein the MCHK7promoter spans nucleotides 130-921, a SV40 chimeric intron spansnucleotides 931-1078, the β-sarcoglycan sequence spans nucleotides1091-2047 and the poly A spans nucleotides 2054-2106.

In some embodiments, the muscle-specific promoter is tMCK (SEQ ID NO:6). An exemplary rAAV described herein is pAAV.tMCK.hSCGB whichcomprises the nucleotide sequence of SEQ ID NO: 5; wherein the tMCKpromoter spans nucleotides 141-854, an SV40 chimeric intron spansnucleotides 886-1018, the β-sarcoglycan sequence spans nucleotides1058-2014 and the poly A spans nucleotides 2021-2073.

The AAV can be any serotype, for example AAV1, AAV2, AAV3, AAV4, AAV5,AAV6, AAV7, AAV8, AAV9, AAV-10, AAV-11, AAV-12, AAV-13 and AAV rh.74.Production of pseudotyped rAAV is disclosed in, for example, WO01/83692. Other types of rAAV variants, for example rAAV with capsidmutations, are also contemplated. See, for example, Marsic et al.,Molecular Therapy, 22(11): 1900-1909 (2014).

Compositions comprising any of the rAAV vectors described herein arealso contemplated.

Methods of producing a recombinant AAV vector particle comprisingculturing a cell that has been transfected with any recombinant AAVvector described herein and recovering recombinant AAV particles fromthe supernatant of the transfected cells are also provided. Viralparticles comprising any of the recombinant AAV vectors described hereinare also contemplated

Methods of reducing fibrosis in a mammalian subject in need thereof isalso provided. In this regard, the method comprises administering atherapeutically effective amount of an AAV vector described herein (orcomposition comprising an AAV vector described herein) to the mammaliansubject. In some embodiments, the mammalian subject suffers frommuscular dystrophy. In some embodiments, administration of an AAV vectordescribed herein (or composition comprising an AAV vector describedherein) reduces fibrosis in skeletal muscle or in cardiac muscle of thesubject. These methods may further comprise the step of administering asecond recombinant AAV vector comprising a polynucleotide sequencecomprising miR29C.

The term “muscular dystrophy” as used herein refers to a disorder inwhich strength and muscle bulk gradually decline. Non-limiting examplesof muscular dystrophy diseases may include Becker muscular dystrophy,tibial muscular dystrophy, Duchenne muscular dystrophy, Emery-Dreifussmuscular dystrophy, facioscapulohumeral muscular dystrophy,sarcoglycanopathies, congenital muscular dystrophy such as congenitalmuscular dystrophy due to partial LAMA2 deficiency, merosin-deficientcongenital muscular dystrophy, type 1D congenital muscular dystrophy,Fukuyama congenital muscular dystrophy, limb-girdle type 1A musculardystrophy, limb-girdle type 2A muscular dystrophy, limb-girdle type 2Bmuscular dystrophy, limb-girdle type 2C muscular dystrophy, limb-girdletype 2D muscular dystrophy, limb-girdle type 2E muscular dystrophy,limb-girdle type 2F muscular dystrophy, limb-girdle type 2G musculardystrophy, limb-girdle type 2H muscular dystrophy, limb-girdle type 21muscular dystrophy, limb-girdle type 21 muscular dystrophy, limb-girdletype 2J muscular dystrophy, limb-girdle type 2K muscular dystrophy,limb-girdle type IC muscular dystrophy, rigid spine muscular dystrophywith epidermolysis bullosa simplex, oculopharyngeal muscular dystrophy,Ullrich congenital muscular dystrophy, and Ullrich scleroatonic musculardystrophy. In some embodiments, the subject is suffering fromlimb-girdle muscular dystrophy. In some embodiments, the subject ussuffering from limb-girdle muscular dystrophy type 2E (LGMD2E).

The term “fibrosis” as used herein refers to the excessive orunregulated deposition of extracellular matrix (ECM) components andabnormal repair processes in tissues upon injury including skeletalmuscle, cardiac muscle, liver, lung, kidney, and pancreas. The ECMcomponents that are deposited include collagen, e.g. collagen 1,collagen 2 or collagen 3, and fibronectin.

In another aspect, described herein is a method of increasing muscularforce and/or muscle mass in a mammalian subject comprising administeringa therapeutically effective amount of an AAV vector described herein (orcomposition comprising an AAV vector described herein) to the mammaliansubject.

In any of the methods of the invention, the subject may be sufferingfrom muscular dystrophy such as limb-girdle muscular dystrophy or anyother dystrophin-associated muscular dystrophy.

Also provided is a method of treating muscular dystrophy in a mammaliansubject comprising administering a therapeutically effective amount ofan AAV vector described herein (or composition comprising an AAV vectordescribed herein) to the mammalian subject. In some embodiments, themuscular dystrophy is limb-girdle muscular dystrophy. Any of the methodsdescribed herein may further comprise the step of administering a secondrecombinant AAV vector comprising a polynucleotide sequence comprisingmiR29C.

Combination therapies are also contemplated. In this regard, any of theforegoing methods described here may further comprise administering asecond recombinant AAV vector comprising a polynucleotide sequencecomprising miR29C. In some embodiments, the polynucleotide comprisingmiR29C is operably linked operably linked to a muscle-specific controlelement. For example the muscle-specific control element is humanskeletal actin gene element, cardiac actin gene element,myocyte-specific enhancer binding factor MEF, muscle creatine kinase(MCK), tMCK (truncated MCK), myosin heavy chain (MHC), MHCK7 (a hybridversion of MHC and MCK), C5-12 (synthetic promoter), murine creatinekinase enhancer element, skeletal fast-twitch troponin C gene element,slow-twitch cardiac troponin C gene element, the slow-twitch troponin Igene element, hypozia-inducible nuclear factors, steroid-inducibleelement or glucocorticoid response element (GRE). In some embodiments,the second recombinant vector comprises a polynucleotide sequence setforth in SEQ ID NO: 9 or SEQ ID NO: 8, as described in U.S. ProvisionalApplication No. 62/323,163 (the disclosure of which is incorporatedherein by reference in its entirety).

In combination therapy methods described herein in which both an rAAVvector expressing β-sarcoglycan and an rAAV vector expressing miR29c areadministered to the mammalian subject, the rAAV vectors may beadministered concurrently, or administered consecutively with the rAAVvector expressing β-sarcoglycan being administered immediately before orafter the rAAV expressing miR29c. Alternatively, the AAV vectorexpressing β-sarcoglycan is administered within about 1-24 hours (e.g.,1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20,21, 22, 23 or 24 hours) after administering the rAAV expressing miR-29or the methods of the invention are carried out wherein the AAV vectorexpressing the β-sarcoglycan is administered within about 1-24 hours(e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18,19, 20, 21, 22, 23 or 24 hours) before administering the rAAV expressingmiR-29. In some embodiments, the AAV vector expressing β-sarcoglycan isadministered within about 1-5 hours (e.g., 1, 2, 3, 4 or 5 hours) afteradministering the rAAV expressing miR-29 or the methods of the inventionare carried out wherein the AAV vector expressing the β-sarcoglycan isadministered within about 1-5 hours (e.g., 1, 2, 3, 4 or 5 hours) beforeadministering the rAAV expressing miR-29c.

In any of the methods of the invention, the rAAV is administered byintramuscular injection or intravenous injection. In addition, in any ofthe method of the invention, the rAAV is administered systemically, suchas parental administration by injection, infusion or implantation.

The compositions of the invention are formulated for intramuscularinjection or intravenous injection. In addition, the compositions of theinvention are formulated for systemic administration, such as parentaladministration by injection, infusion or implantation.

In addition, any of the compositions formulated for administration to asubject suffering from muscular dystrophy (such as limb-girdle musculardystrophy or any other dystrophin-associated muscular dystrophy). Insome embodiments, the composition may further comprise a secondrecombinant AAV vector comprising a polynucleotide sequence set forth inSEQ ID NO: 9 or SEQ ID NO: 8.

In any of the uses of the invention, the medicament is formulated forintramuscular injection or intravenous injection. In addition, in any ofthe uses of the invention, the medicament is formulated for systemicadministration, such as parental administration by injection, infusionor implantation. In addition, any of the medicaments may be prepared foradministration to a subject suffering from muscular dystrophy (such aslimb-girdle muscular dystrophy or any other dystrophin associatedmuscular dystrophy). In some embodiments, the medicament may furthercomprise a second recombinant AAV vector comprising a polynucleotidesequence set forth in SEQ ID NO: 9 or SEQ ID NO: 8.

The foregoing paragraphs are not intended to define every aspect of theinvention, and additional aspects are described in other sections, suchas the Detailed Description. The entire document is intended to berelated as a unified disclosure, and it should be understood that allcombinations of features described herein are contemplated, even if thecombination of features are not found together in the same sentence, orparagraph, or section of this document. The invention includes, as anadditional aspect, all embodiments of the invention narrower in scope inany way than the variations defined by specific paragraphs above. Forexample, where certain aspects of the invention that are described as agenus, it should be understood that every member of a genus is,individually, an aspect of the invention.

BRIEF DESCRIPTION OF THE FIGURES

FIGS. 1A-1D demonstrate that AAV mediated β-sarcoglycan expressionrestores dystrophin-associated proteins and protects membrane integrity.(a) Self-complementary AAV vector containing the codon-optimized humanβ-sarcoglycan gene (hSGCB) driven by the muscle-specific tMCK promoter.The cassette also contains a chimeric intron to augment processing andpolyadenylation signal for stability. (b) Immunofluorescence stainingwith anti-β-SG antibody shows high levels of sarcolemmal staining of theSGCB transgene in 5-week-old mice both 6 and 12 weeks post injection.×20 images shown. Percentage of fibers expressing beta-sarcoglycan perTA muscle averaged 88.4±4.2% after 6 weeks (n=9, 4 male, 5 female) and76.5±5.8% after 12 weeks (n=6, 4 male, 2 female). Protein expressionconfirmed in the western blot with gamma-tubulin blot shown for aloading control. (c) AAV delivery of β-sarcoglycan leads to restorationof other members of the sarcoglycan complex; α-sarcoglycan, dystrophin.×20 images. (d) scAAVrh.74.hSGCB protects sgcb−/− membranes from damage.Image showing a large area of Evans blue-positive fibers (red)juxtaposed to a cluster of β-sarcoglycan-positive fibers that have beenprotected from Evans blue dye incorporation. ×40 image is shown.

FIGS. 2A-2E shows the histological analysis of β-SG-deficient treatedskeletal muscle. scAAVrh.74.hSGCB treatment normalizes histologicalparameters of sgcb^(−/−) mice. Hematoxylin & Eosin staining andPicrosirius Red staining were performed on TA muscle from sgcb^(−/−)mice along with normal control C57/BL6 mice and scAAVrh.74.hSGCB-treatedmice followed by quantification of histological parameters and %collagen staining. (a) H&E staining shows the presence of centrallynucleated fibers, inflammatory cells and large fiber diameterdistribution in β-SG-deficient muscle and an improvement inhistopathology following gene transfer. (b) Pircrosirius Red stainingshows a decrease in red collagen staining in treated muscle. (c)Quantification of centrally nucleated fibers showing a decreasefollowing treatment (P<0.0005, one-way ANOVA) and (d) representation offiber size distribution and increase in average fiber size of TA musclefrom C57/BL6 controls and sgcb^(−/−) mice compared with treated mice(P<0.0001, one-way ANOVA). (e) Quantification of % collagen in TA musclefrom C57/BL6 controls and sgcb^(−/−) mice compared with sgcb^(−/−)treated mice (P<0.0001, one-way ANOVA). 100 μm scale bar shown for ×20images. ***P<0.001; ****P<0.0001.

FIGS. 3A-3C shows that scAAVrh.74.hSGCB intramuscular delivery correctstetanic force and resistance to contraction-induced injury. The TAmuscle of sgcb^(−/−) mice treated with 3×10¹⁰ vg of scAAVrh.74.hSGCB viaan IM injection was harvested 6 weeks post gene transfer, and subjectedto a protocol to assess tetanic force and an eccentric contractionprotocol to assess resistance to contraction-induced injury. (a)AAVrh.74.hSGCB-treated TA's demonstrated significant improvement in bothabsolute tetanic force (P<0.01, paired t-test) and (b) normalizedspecific force (P<0.05, paired t-test), which was not different fromwild-type force (C57/BL6). (c) AAVrh.74.hSGCB treated TA's exhibitedsignificant improvement in resistance to contraction-induced injurycompared with untreated sgcb^(−/−) controls (P<0.01, two-way ANOVA).Force retention following 10 contractions is shown. *P<0.05; **P<0.01.

FIGS. 4A-4C shows the results of the analysis of aged mice treatedintramuscularly with scAAVrh.74.tMCK.hSGCB. (a) Immunofluorescencestaining of TA muscle from 6-month-old treated sgcb^(−/−) mice 12 weekspost injection (n=5, 5 male) shows sarcolemmal expression of the SGCBtransgene at levels averaging 80% in injected mice compared withuntreated (n=4, 4 male). (b) Picrosirius red staining of the treated anduntreated TA muscle. (c) Quantitation of collagen present in thePicrosirius red stained tissue shows a significant reduction in theamount of collagen following treatment with rAAVrh.74.tMCK.hSGCB(P<0.0001, one-way ANOVA). 100 μm scale bar shown for ×20 images.****P<0.0001.

FIGS. 5A-5C show the results of vascular delivery of scAAVrh.74.hSGCB.Four (n=5, 5 male) and five (n=4, 2 male, 2 female) weeks β-SG-deficientmice were treated with vector via the femoral artery to deliver thevector to the lower limb muscles. At a dose of 5×10¹¹ vg, β-SGexpression was 90.6±2.8% in the TA and 91.8±4.7% in the GAS of treatedmice accompanied by improvements in histopathology that resulted insignificant improvement in specific force compared with untreatedanimals even following an injury paradigm. (a) β-SG protein expressionfrom three representative mice. Muscle from a β-SG KO untreated mouse isshown for comparison in the inset (lower right). ×20 Images are shown.Expression in treated muscles confirmed via western blot andgamma-tubulin is shown as a loading control. (b) Histopathology issignificantly improved following high dose treatment. Upperpanels-treated TA and gastrocnemius muscles. Bottom panels-untreated(3-SG-deficient control muscle. 100 μm scale bar shown for ×20 images.(c) Percentage of specific force retained in EDL muscle following 10cycles of eccentric contraction-induced injury. Treatment with 5×10¹¹ vgof AAVrh.74.hSGCB led to significant improvement in force that wasequivalent to WT (normal) control muscle (P<0.05, one-way ANOVA).*P<0.05.

FIGS. 6A-6B show reduction of fibrosis in ILP-treated β-SG KO mice. (a)Picrosirius red staining shows reduced fibrosis in treated miceindicated by a decrease in collagen deposition compared with untreatedsgcb^(−/−) mice. (b) Quantification of collagen levels in the TA and GASmuscles from BL6 WT, untreated sgcb^(−/−) mice, and treated mice confirmreduction in collagen levels in treated mice (P<0.001, one-way ANOVA).100 μm scale bar shown for ×20 images. ***P<0.001.

FIGS. 7A and 7B show vector biodistribution and protein expression. (a)Histogram of average distribution of vector in harvested tissues fromILP-treated mice given in copies of transcript per microgram of DNAadded to qPCR. Left limb was treated. (b) No protein expression viawestern blot seen in off target organs.

FIG. 8A-D provide histological and functional deficits in sgcb^(−/−)mice at 7 months of age. Trichome staining in the diaphragm (A) andheart (C) of SGCB^(−/−) mice shows extensive fibrosis (red). The forceoutput from the diaphragm is significantly reduced in the diaphragm (B)and the cardiac ejection fraction is also reduced in sgcb^(−/−) mice(D).

FIG. 9 provides a schematic of therapeutic β-sarcoglycan transgenecassette. Self-complementary AAV vector containing the codon-optimizedhuman β-sarcoglycan gene (hSGCB). A muscle specific MHCK7 promoterdrives expression. The cassette also contains a chimeric intron toaugment processing and polyadenylation signal for stability.

FIG. 10 provides immunofluorescence staining for β-sarcoglycan invarious skeletal muscles demonstrates robust expression with rarenegative fibers after 1, 4, or 6 months of treatment (1 month shown).

FIG. 11 provides immunofluorescence staining for β-sarcoglycan indiaphragm and heart demonstrates robust expression with rare negativefibers after 1, 4, or 6 months of treatment (1 month shown).

FIG. 12A-D depicts restoration of SGCB expression following intravenousdelivery of scAAVrh.74.MHCK7.hSGCB. (A) scAAVrh.74.MHCK7.hSGCB cassette.(b) Immunofluorescence imaging 6 months post-injection of skeletalmuscles, diaphragm, and heart from sgcb^(−/−) mice intravenouslyinjected with 1e12 vg total dose scAAVrh.74.MHCK7.hSGCB. Representativeimages of skeletal muscles displaying an average of 98.13±0.31%transduction. 20× images are shown. Representative images of hearttissue displaying high levels of hSGCB transgene expression. 10× imagesare shown. (c) Western blotting of all muscles from one treatedsgcb^(−/−) mouse confirming hSGCB transgene expression. (d) Westernblotting for hSGCB expression in hearts of five sgcb^(−/−) treated micewith densitometry quantification showing overexpression of hSGCB up to72.0% of BL6 WT levels.

FIG. 13A-D depicts the effect of systemic treatment withscAAVrh74.MHCK7.hSGCB on muscle pathology. (a) H&E stain of diaphragmand QUAD muscle from C57BL/6 WT, sgcb^(−/−), and scAAVrh.74.MHCK7.hSGCBtreated mice showing normalized histopathology. (b) Quantification ofreduction in centrally nucleated fibers in sgcb^(−/−) treated musclecompared to untreated sgcb^(−/−) muscle (TA, GAS, GLUT, diaphragm,p<0.0001) (QUAD, PSOAS, TRI, p<0.05). (c) Normalization of fiberdistribution in GAS, PSOAS, and TRI, and (d) increase in average fibersize in treated muscles compared to untreated sgcb−/− muscles (p<0.001)(ONE-WAY ANOVA) (n=5 per group).

FIGS. 14A and 14B depict reduced collagen deposition in intravenoustreated β-SG KO mice. (a) Picrosirius red staining showed reducedfibrosis in treated mice indicated by a decrease in collagen depositioncompared to untreated sgcb^(−/−) mice in diaphragm and GAS. (b)Quantification of collagen levels in the diaphragm and GAS muscles fromC57BL/6 WT mice (n=4), untreated sgcb^(−/−) mice (n=4), and treatedsgcb^(−/−) mice (n=5) confirm reduction in collagen levels in bothtreated muscles (p<0.0001, ONE-WAY ANOVA). 100 μm scale bar shown for20× images.

FIG. 15 demonstrates delivery of scAAVrh.74.MHCK7.hSGCB via the tailvein of sgcb⁻/− mice completely restores force in the diaphragm.following 6 months of treatment (IV administration (1e12vg)). Diaphragmmuscle strips were harvested from treated and control SGCB^(−/−) miceand WT mice and subjected to force measurements, treatment restoredforce to WT levels.

FIG. 16 provides a schematic of rAAV vector scAACrh.74.CMV.miR29c andthe nucleotide sequence of the miR-29c in a natural miR-30 backbone.

FIG. 17 demonstrates that following 3 months of treatment withAAVrh.74.CMV.miR29C, TA muscles were harvested from treated and controlSGCB^(−/−) mice and WT mice and analyzed for fibrosis (collagen levels)(n=5 per group). Using sirius red staining and quantification, collagenlevels were reduced following treatment (see FIG. 18). Results indicatedthat transcript levels of Col1A, Col3A, and Fbn were normalized andmuscle fiber size was increased.

FIG. 18 provides representative images of scanned full sections ofuntreated and AAVrh.74.CMV.miR29C treated tibialis anterior musclesstained with Sirius Red which stains for collagen 1 and 3.Quantification is shown in FIG. 17

FIGS. 19A and 19B demonstrate correction of kyphoscoliosis in thoracicspine. (a) Kyphoscoliosis in sgcb^(−/−) mice as evidenced by X-rayradiography. (b) The Kyphotic Index (KI) score of sgcb^(−/)− mice (3.69)is low compared to C57BL/6 WT (6.01) (p<0.01), but increases upontreatment with scAAVrh.74.MHCK7.hSGCB (5.39) (p<0.05 compared tosgcb^(−/)−) (ONE-WAY ANOVA) (n=6 per group).

FIG. 20A-D provide the assessment of cardiomyopathy in heart muscle. (a)H&E and picrosirius red stains of 7 month old BL6 WT, sgcb^(−/−), andAAV.MHCK7.hSGCB treated sgcb^(−/−) hearts 6 months post-treatmentindicating myocardial degeneration in untreated sgcb^(−/−) muscle andimprovement following treatment. (b) Cardiac Mill analysis showingreduction in sgcb^(−/−) hearts in stroke volume (p<0.01), cardiacoutput, and ejection fraction (p<0.05) (ONE-WAY ANOVA) and improvements6 months after treatment (n=6 per group). (c) Western blotting of twoC57BL/6 WT hearts, two sgcb^(−/−) hearts, and five AAV.MHCK7.hSGCBtreated sgcb^(−/−) hearts showing decreased cardiac troponin I levels indiseased mice. (d) Densitometry quantification showing reduction ofcardiac troponin I (cTrpI) to 60.38% of BL6 WT levels and anoverexpression of up to 135.8% of BL6 WT levels.

FIG. 21A-B demonstrates diaphragm function correction and increasedopen-field cage activity. (a) Diaphragm muscle strips were harvested tomeasure force and resistance to fatigue in BL6 WT mice (n=5), sgcb^(−/−)mice (n=4), and AAV.MHCK7.hSGCB treated sgcb^(−/−) mice (n=5) all at 7months of age. Six months of treatment restored force to WT levels(p<0.01 compared to sgcb^(−/−)) and improved resistance to fatigue. (b)Overall ambulation in x and y planes is significantly decreased insgcb^(−/−) mice (p<0.0001) and slightly improved in MCHK7 treated mice(p<0.05). Vertical activity rearing onto hindlimbs also decreased insgcb^(−/−) mice (p<0.01) and significantly increased in MCHK7 treatedmice (p<0.05) (ONE-WAY ANOVA) (n=6 per group).

FIG. 22A-B provide biodistibution and off-target transgene expressionanalysis of systemic scAAVrh.74.MHCK7.hSGCB delivery. (a) Distributionhistogram of average vg copies of transcript per microgram DNA added toqPCR reaction in various tissues from two sgcb^(−/−) mice after IVdelivery of scAAVrh.74.MHCK7.hSGCB at 1e12 vg total dose. (b)Biodistribution westerns on muscles and organs fromscAAVrh.74.MHCK7.hSGCB systemically injected sgcb^(−/−) mice indicatingno expression of hSGCB transgene in any non-muscle samples.

DETAILED DESCRIPTION

The present disclosure is based on the discovery that administration ofan AAV vector comprising a polynucleotide expressing β-sarcoglycanresults in a reduction or complete reversal of muscle fibrosis in alimb-girdle muscular dystrophy animal model. As demonstrated in theExamples, administration of the AAV vector described herein resulted inthe reversal of dystrophic features including fewer degenerating fibers,reduced inflammation and improved functional recovery by protectionagainst eccentric contraction with increased force generation.

As used herein, the term “AAV” is a standard abbreviation foradeno-associated virus. Adeno-associated virus is a single-stranded DNAparvovirus that grows only in cells in which certain functions areprovided by a co-infecting helper virus. There are currently thirteenserotypes of AAV that have been characterized. General information andreviews of AAV can be found in, for example, Carter, 1989, Handbook ofParvoviruses, Vol. 1, pp. 169-228, and Berns, 1990, Virology, pp.1743-1764, Raven Press, (New York). However, it is fully expected thatthese same principles will be applicable to additional AAV serotypessince it is well known that the various serotypes are quite closelyrelated, both structurally and functionally, even at the genetic level.(See, for example, Blacklowe, 1988, pp. 165-174 of Parvoviruses andHuman Disease, J. R. Pattison, ed.; and Rose, Comprehensive Virology3:1-61 (1974)). For example, all AAV serotypes apparently exhibit verysimilar replication properties mediated by homologous rep genes; and allbear three related capsid proteins such as those expressed in AAV2. Thedegree of relatedness is further suggested by heteroduplex analysiswhich reveals extensive cross-hybridization between serotypes along thelength of the genome; and the presence of analogous self-annealingsegments at the termini that correspond to “inverted terminal repeatsequences” (ITRs). The similar infectivity patterns also suggest thatthe replication functions in each serotype are under similar regulatorycontrol.

An “AAV vector” as used herein refers to a vector comprising one or morepolynucleotides of interest (or transgenes) that are flanked by AAVterminal repeat sequences (ITRs). Such AAV vectors can be replicated andpackaged into infectious viral particles when present in a host cellthat has been transfected with a vector encoding and expressing rep andcap gene products.

An “AAV virion” or “AAV viral particle” or “AAV vector particle” refersto a viral particle composed of at least one AAV capsid protein and anencapsidated polynucleotide AAV vector. If the particle comprises aheterologous polynucleotide (i.e. a polynucleotide other than awild-type AAV genome such as a transgene to be delivered to a mammaliancell), it is typically referred to as an “AAV vector particle” or simplyan “AAV vector”. Thus, production of AAV vector particle necessarilyincludes production of AAV vector, as such a vector is contained withinan AAV vector particle.

AAV

Recombinant AAV genomes of the invention comprise nucleic acid moleculeof the invention and one or more AAV ITRs flanking a nucleic acidmolecule. AAV DNA in the rAAV genomes may be from any AAV serotype forwhich a recombinant virus can be derived including, but not limited to,AAV serotypes AAV-1, AAV-2, AAV-3, AAV-4, AAV-5, AAV-6, AAV-7, AAV-8,AAV-9, AAV-10, AAV-11, AAV-12, AAV-13 and AAV rh.74. Production ofpseudotyped rAAV is disclosed in, for example, WO 01/83692. Other typesof rAAV variants, for example rAAV with capsid mutations, are alsocontemplated. See, for example, Marsic et al., Molecular Therapy,22(11): 1900-1909 (2014). As noted in the Background section above, thenucleotide sequences of the genomes of various AAV serotypes are knownin the art. To promote skeletal muscle specific expression, AAV1, AAV5,AAV6, AAV8 or AAV9 may be used.

DNA plasmids of the invention comprise rAAV genomes. The DNA plasmidsare transferred to cells permissible for infection with a helper virusof AAV (e.g., adenovirus, E1-deleted adenovirus or herpesvirus) forassembly of the rAAV genome into infectious viral particles. Techniquesto produce rAAV particles, in which an AAV genome to be packaged, repand cap genes, and helper virus functions are provided to a cell arestandard in the art. Production of rAAV requires that the followingcomponents are present within a single cell (denoted herein as apackaging cell): a rAAV genome, AAV rep and cap genes separate from(i.e., not in) the rAAV genome, and helper virus functions. The AAV repand cap genes may be from any AAV serotype for which recombinant viruscan be derived and may be from a different AAV serotype than the rAAVgenome ITRs, including, but not limited to, AAV serotypes AAV-1, AAV-2,AAV-3, AAV-4, AAV-5, AAV-6, AAV-7, AAV-8, AAV-9, AAV-10, AAV-11, AAV-12,AAV-13 and AAV rh.74. Production of pseudotyped rAAV is disclosed in,for example, WO 01/83692 which is incorporated by reference herein inits entirety.

A method of generating a packaging cell is to create a cell line thatstably expresses all the necessary components for AAV particleproduction. For example, a plasmid (or multiple plasmids) comprising arAAV genome lacking AAV rep and cap genes, AAV rep and cap genesseparate from the rAAV genome, and a selectable marker, such as aneomycin resistance gene, are integrated into the genome of a cell. AAVgenomes have been introduced into bacterial plasmids by procedures suchas GC tailing (Samulski et al., 1982, Proc. Natl. Acad. S6. USA,79:2077-2081), addition of synthetic linkers containing restrictionendonuclease cleavage sites (Laughlin et al., 1983, Gene, 23:65-73) orby direct, blunt-end ligation (Senapathy & Carter, 1984, J. Biol. Chem.,259:4661-4666). The packaging cell line is then infected with a helpervirus such as adenovirus. The advantages of this method are that thecells are selectable and are suitable for large-scale production ofrAAV. Other examples of suitable methods employ adenovirus orbaculovirus rather than plasmids to introduce rAAV genomes and/or repand cap genes into packaging cells.

General principles of rAAV production are reviewed in, for example,Carter, 1992, Current Opinions in Biotechnology, 1533-539; and Muzyczka,1992, Curr. Topics in Microbial. and Immunol., 158:97-129). Variousapproaches are described in Ratschin et al., Mol. Cell. Biol. 4:2072(1984); Hermonat et al., Proc. Natl. Acad. Sci. USA, 81:6466 (1984);Tratschin et al., Mol. Cell. Biol. 5:3251 (1985); McLaughlin et al., J.Virol., 62:1963 (1988); and Lebkowski et al., 1988 Mol. Cell. Biol.,7:349 (1988). Samulski et al. (1989, J. Virol., 63:3822-3828); U.S. Pat.No. 5,173,414; WO 95/13365 and corresponding U.S. Pat. No. 5,658,776; WO95/13392; WO 96/17947; PCT/US98/18600; WO 97/09441 (PCT/US96/14423); WO97/08298 (PCT/US96/13872); WO 97/21825 (PCT/US96/20777); WO 97/06243(PCT/FR96/01064); WO 99/11764; Perrin et al. (1995) Vaccine13:1244-1250; Paul et al. (1993) Human Gene Therapy 4:609-615; Clark etal. (1996) Gene Therapy 3:1124-1132; U.S. Pat. Nos. 5,786,211;5,871,982; and 6,258,595. The foregoing documents are herebyincorporated by reference in their entirety herein, with particularemphasis on those sections of the documents relating to rAAV production.

The invention thus provides packaging cells that produce infectiousrAAV. In one embodiment packaging cells may be stably transformed cancercells such as HeLa cells, 293 cells and PerC.6 cells (a cognate 293line). In another embodiment, packaging cells are cells that are nottransformed cancer cells, such as low passage 293 cells (human fetalkidney cells transformed with E1 of adenovirus), MRC-5 cells (humanfetal fibroblasts), WI-38 cells (human fetal fibroblasts), Vero cells(monkey kidney cells) and FRhL-2 cells (rhesus fetal lung cells).

Recombinant AAV (i.e., infectious encapsidated rAAV particles) of theinvention comprise a rAAV genome. Embodiments include, but are notlimited to, the rAAV named pAAV.MHCK7.hSCGB which comprises thepolynucleotide sequence set forth in SEQ ID NO: 3; and pAAV.tMCK.hSCGBwhich comprises the polynucleotide sequence set forth in SEQ ID NO: 5.

The rAAV may be purified by methods standard in the art such as bycolumn chromatography or cesium chloride gradients. Methods forpurifying rAAV vectors from helper virus are known in the art andinclude methods disclosed in, for example, Clark et al., Hum. GeneTher., 10(6): 1031-1039 (1999); Schenpp and Clark, Methods Mol. Med., 69427-443 (2002); U.S. Pat. No. 6,566,118 and WO 98/09657.

In another embodiment, the invention contemplates compositionscomprising rAAV of the present invention. Compositions described hereincomprise rAAV in a pharmaceutically acceptable carrier. The compositionsmay also comprise other ingredients such as diluents and adjuvants.Acceptable carriers, diluents and adjuvants are nontoxic to recipientsand are preferably inert at the dosages and concentrations employed, andinclude buffers such as phosphate, citrate, or other organic acids;antioxidants such as ascorbic acid; low molecular weight polypeptides;proteins, such as serum albumin, gelatin, or immunoglobulins;hydrophilic polymers such as polyvinylpyrrolidone; amino acids such asglycine, glutamine, asparagine, arginine or lysine; monosaccharides,disaccharides, and other carbohydrates including glucose, mannose, ordextrins; chelating agents such as EDTA; sugar alcohols such as mannitolor sorbitol; salt-forming counterions such as sodium; and/or nonionicsurfactants such as Tween, pluronics or polyethylene glycol (PEG).

Titers of rAAV to be administered in methods of the invention will varydepending, for example, on the particular rAAV, the mode ofadministration, the treatment goal, the individual, and the cell type(s)being targeted, and may be determined by methods standard in the art.Titers of rAAV may range from about 1×10⁶, about 1×10⁷, about 1×10⁸,about 1×10⁹, about 1×10¹⁰, about 1×10¹¹, about 1×10¹², about 1×10¹³ toabout 1×10¹⁴ or more DNase resistant particles (DRP) per ml. Dosages mayalso be expressed in units of viral genomes (vg).

Methods of transducing a target cell with rAAV, in vivo or in vitro, arecontemplated by the invention. The in vivo methods comprise the step ofadministering an effective dose, or effective multiple doses, of acomposition comprising a rAAV of the invention to an animal (including ahuman being) in need thereof. If the dose is administered prior todevelopment of a disorder/disease, the administration is prophylactic.If the dose is administered after the development of a disorder/disease,the administration is therapeutic. In embodiments of the invention, aneffective dose is a dose that alleviates (eliminates or reduces) atleast one symptom associated with the disorder/disease state beingtreated, that slows or prevents progression to a disorder/disease state,that slows or prevents progression of a disorder/disease state, thatdiminishes the extent of disease, that results in remission (partial ortotal) of disease, and/or that prolongs survival. An example of adisease contemplated for prevention or treatment with methods of theinvention is muscular dystrophy, such as limb-girdle muscular dystrophy

Combination therapies are also contemplated by the invention.Combination as used herein includes both simultaneous treatment orsequential treatments. Combinations of methods of the invention withstandard medical treatments (e.g., corticosteroids) are specificallycontemplated, as are combinations with novel therapies.

A therapeutically effective amount of the rAAV vector is a dose of rAAVranging from about 1e13 vg/kg to about 5e14 vg/kg, or about 1e13 vg/kgto about 2e13 vg/kg, or about 1e13 vg/kg to about 3e13 vg/kg, or about1e13 vg/kg to about 4e13 vg/kg, or about 1e13 vg/kg to about 5e13 vg/kg,or about 1e13 vg/kg to about 6e13 vg/kg, or about 1e13 vg/kg to about7e13 vg/kg, or about 1e13 vg/kg to about 8e13 vg/kg, or about 1e13 vg/kgto about 9e13 vg/kg, or about 1e13 vg/kg to about 1e14 vg/kg, or about1e13 vg/kg to about 2e14 vg/kg, or 1e13 vg/kg to about 3e14 vg/kg, orabout 1e13 to about 4e14 vg/kg, or about 3e13 vg/kg to about 4e13 vg/kg,or about 3e13 vg/kg to about 5e13 vg/kg, or about 3e13 vg/kg to about6e13 vg/kg, or about 3e13 vg/kg to about 7e13 vg/kg, or about 3e13 vg/kgto about 8e13 vg/kg, or about 3e13 vg/kg to about 9e13 vg/kg, or about3e13 vg/kg to about 1e14 vg/kg, or about 3e13 vg/kg to about 2e14 vg/kg,or 3e13 vg/kg to about 3e14 vg/kg, or about 3e13 to about 4e14 vg/kg, orabout 3e13 vg/kg to about 5e14 vg/kg, or about 5e13 vg/kg to about 6e13vg/kg, or about 5e13 vg/kg to about 7e13 vg/kg, or about 5e13 vg/kg toabout 8e13 vg/kg, or about 5e13 vg/kg to about 9e13 vg/kg, or about 5e13vg/kg to about 1e14 vg/kg, or about 5e13 vg/kg to about 2e14 vg/kg, or5e13 vg/kg to about 3e14 vg/kg, or about 5e13 to about 4e14 vg/kg, orabout 5e13 vg/kg to about 5e14 vg/kg, or about 1e14 vg/kg to about 2e14vg/kg, or 1e14 vg/kg to about 3e14 vg/kg, or about 1e14 to about 4e14vg/kg, or about 1e14 vg/kg to about 5e14 vg/kg. The invention alsocomprises compositions comprising these ranges of rAAV vector.

For example, a therapeutically effective amount of rAAV vector is a doseof 1e13 vg/kg, about 2e13 vg/kg, about 3e13 vg/kg, about 4e13 vg/kg,about 5e13 vg/kg, about 6e13 vg/kg, about 7e13 vg/kg, about 8e13 vg/kg,about 9e13 vg/kg, about 1e14 vg/kg, about 2e14 vg/kg, about 3e14 vg/kg,about 4e14 vg/kg and 5e14 vg/kg. The invention also comprisescompositions comprising these doses of rAAV vector.

Administration of an effective dose of the compositions may be by routesstandard in the art including, but not limited to, intramuscular,parenteral, intravenous, oral, buccal, nasal, pulmonary, intracranial,intraosseous, intraocular, rectal, or vaginal. Route(s) ofadministration and serotype(s) of AAV components of the rAAV (inparticular, the AAV ITRs and capsid protein) of the invention may bechosen and/or matched by those skilled in the art taking into accountthe infection and/or disease state being treated and the targetcells/tissue(s) that are to express the β-sarcoglycan.

The invention provides for local administration and systemicadministration of an effective dose of rAAV and compositions of theinvention. For example, systemic administration is administration intothe circulatory system so that the entire body is affected. Systemicadministration includes enteral administration such as absorptionthrough the gastrointestinal tract and parental administration throughinjection, infusion or implantation.

In particular, actual administration of rAAV of the present inventionmay be accomplished by using any physical method that will transport therAAV recombinant vector into the target tissue of an animal.Administration according to the invention includes, but is not limitedto, injection into muscle, the bloodstream and/or directly into theliver. Simply resuspending a rAAV in phosphate buffered saline has beendemonstrated to be sufficient to provide a vehicle useful for muscletissue expression, and there are no known restrictions on the carriersor other components that can be co-administered with the rAAV (althoughcompositions that degrade DNA should be avoided in the normal mannerwith rAAV). Capsid proteins of a rAAV may be modified so that the rAAVis targeted to a particular target tissue of interest such as muscle.See, for example, WO 02/053703, the disclosure of which is incorporatedby reference herein. Pharmaceutical compositions can be prepared asinjectable formulations or as topical formulations to be delivered tothe muscles by transdermal transport. Numerous formulations for bothintramuscular injection and transdermal transport have been previouslydeveloped and can be used in the practice of the invention. The rAAV canbe used with any pharmaceutically acceptable carrier for ease ofadministration and handling.

For purposes of intramuscular injection, solutions in an adjuvant suchas sesame or peanut oil or in aqueous propylene glycol can be employed,as well as sterile aqueous solutions. Such aqueous solutions can bebuffered, if desired, and the liquid diluent first rendered isotonicwith saline or glucose. Solutions of rAAV as a free acid (DNA containsacidic phosphate groups) or a pharmacologically acceptable salt can beprepared in water suitably mixed with a surfactant such ashydroxpropylcellulose. A dispersion of rAAV can also be prepared inglycerol, liquid polyethylene glycols and mixtures thereof and in oils.Under ordinary conditions of storage and use, these preparations containa preservative to prevent the growth of microorganisms. In thisconnection, the sterile aqueous media employed are all readilyobtainable by standard techniques well-known to those skilled in theart.

The pharmaceutical forms suitable for injectable use include sterileaqueous solutions or dispersions and sterile powders for theextemporaneous preparation of sterile injectable solutions ordispersions. In all cases the form must be sterile and must be fluid tothe extent that easy syringability exists. It must be stable under theconditions of manufacture and storage and must be preserved against thecontaminating actions of microorganisms such as bacteria and fungi. Thecarrier can be a solvent or dispersion medium containing, for example,water, ethanol, polyol (for example, glycerol, propylene glycol, liquidpolyethylene glycol and the like), suitable mixtures thereof, andvegetable oils. The proper fluidity can be maintained, for example, bythe use of a coating such as lecithin, by the maintenance of therequired particle size in the case of a dispersion and by the use ofsurfactants. The prevention of the action of microorganisms can bebrought about by various antibacterial and antifungal agents, forexample, parabens, chlorobutanol, phenol, sorbic acid, thimerosal andthe like. In many cases it will be preferable to include isotonicagents, for example, sugars or sodium chloride. Prolonged absorption ofthe injectable compositions can be brought about by use of agentsdelaying absorption, for example, aluminum monostearate and gelatin.

Sterile injectable solutions are prepared by incorporating rAAV in therequired amount in the appropriate solvent with various otheringredients enumerated above, as required, followed by filtersterilization. Generally, dispersions are prepared by incorporating thesterilized active ingredient into a sterile vehicle which contains thebasic dispersion medium and the required other ingredients from thoseenumerated above. In the case of sterile powders for the preparation ofsterile injectable solutions, the preferred methods of preparation arevacuum drying and the freeze drying technique that yield a powder of theactive ingredient plus any additional desired ingredient from thepreviously sterile-filtered solution thereof.

Transduction with rAAV may also be carried out in vitro. In oneembodiment, desired target muscle cells are removed from the subject,transduced with rAAV and reintroduced into the subject. Alternatively,syngeneic or xenogeneic muscle cells can be used where those cells willnot generate an inappropriate immune response in the subject.

Suitable methods for the transduction and reintroduction of transducedcells into a subject are known in the art. In one embodiment, cells canbe transduced in vitro by combining rAAV with muscle cells, e.g., inappropriate media, and screening for those cells harboring the DNA ofinterest using conventional techniques such as Southern blots and/orPCR, or by using selectable markers. Transduced cells can then beformulated into pharmaceutical compositions, and the compositionintroduced into the subject by various techniques, such as byintramuscular, intravenous, subcutaneous and intraperitoneal injection,or by injection into smooth and cardiac muscle, using e.g., a catheter.

Transduction of cells with rAAV of the invention results in sustainedexpression of β-sarcoglycan. The present invention thus provides methodsof administering/delivering rAAV which express β-sarcoglycan to amammalian subject, preferably a human being. These methods includetransducing tissues (including, but not limited to, tissues such asmuscle, organs such as liver and brain, and glands such as salivaryglands) with one or more rAAV of the present invention. Transduction maybe carried out with gene cassettes comprising tissue specific controlelements. For example, one embodiment of the invention provides methodsof transducing muscle cells and muscle tissues directed by musclespecific control elements, including, but not limited to, those derivedfrom the actin and myosin gene families, such as from the myoD genefamily [See Weintraub et al., Science, 251: 761-766 (1991)], themyocyte-specific enhancer binding factor MEF-2 [Cserjesi and Olson, MolCell Biol 11: 4854-4862 (1991)], control elements derived from the humanskeletal actin gene [Muscat et al., Mol Cell Biol, 7: 4089-4099 (1987)],the cardiac actin gene, muscle creatine kinase sequence elements [SeeJohnson et al., Mol Cell Biol, 9:3393-3399 (1989)] and the murinecreatine kinase enhancer (mCK) element, control elements derived fromthe skeletal fast-twitch troponin C gene, the slow-twitch cardiactroponin C gene and the slow-twitch troponin I gene: hypoxia-induciblenuclear factors (Semenza et al., Proc Natl Acad Sci USA, 88: 5680-5684(1991)), steroid-inducible elements and promoters including theglucocorticoid response element (GRE) (See Mader and White, Proc. Natl.Acad. Sci. USA 90: 5603-5607 (1993)), and other control elements.

Muscle tissue is an attractive target for in vivo DNA delivery, becauseit is not a vital organ and is easy to access. The inventioncontemplates sustained expression of miRNAs from transduced myofibers.

By “muscle cell” or “muscle tissue” is meant a cell or group of cellsderived from muscle of any kind (for example, skeletal muscle and smoothmuscle, e.g. from the digestive tract, urinary bladder, blood vessels orcardiac tissue). Such muscle cells may be differentiated orundifferentiated, such as myoblasts, myocytes, myotubes, cardiomyocytesand cardiomyoblasts.

The term “transduction” is used to refer to the administration/deliveryof a polynucleotide of interest (e.g., a polynucleotide sequenceencoding β-sarcoglycan) to a recipient cell either in vivo or in vitro,via a replication-deficient rAAV described resulting in expression ofβ-sarcoglycan by the recipient cell.

Thus, also described herein are methods of administering an effectivedose (or doses, administered essentially simultaneously or doses givenat intervals) of rAAV that encode β-sarcoglycan to a mammalian subjectin need thereof.

All publications and patents mentioned herein are hereby incorporated byreference in their entirety as if each individual publication or patentwas specifically and individually indicated to be incorporated byreference. In case of conflict, the present application, including anydefinitions herein, will control.

The invention is further described in the following Examples, which donot limit the scope of the invention described in the claims.

EXAMPLES Materials and Methods

Animal models—All procedures were approved by The Research Institute atNationwide Children's Hospital Institutional Animal Care and UseCommittee (protocol AR12-00040). B6.129-Sgcb^(tm1Kcam/1J) heterozygousmice were purchased from the Jackson Laboratory (Bar Harbor, Me., USA;Strain #006832). Sgcb^(−/−) mice were generated by breeding heterozygousmice. KO mice were bred and maintained as homozygous animals instandardized conditions in the Animal Resources Core at the ResearchInstitute at Nationwide Children's Hospital. Mice were maintained onTeklad Global Rodent Diet (3.8z5 fiber, 18.8% protein, 5% fat chow) witha 12:12-h dark:light cycle. Identification of SGCB^(−/−) mice wasperformed by genotyping using PCR. All animals were housed in standardmouse cages with food and water ad libitum.

Beta-sarcoglycan gene construction. The full-length humanbeta-sarcoglycan cDNA (GenBank Accession No. NM_0034994.3) was codonoptimized and synthesized by GenScript Inc, Piscataway, N.J., USA. Codonoptimization through GenScript uses an algorithm that takes into accountparameters that include transcription, mRNA processing and stability,translation and protein folding to design a cDNA sequence that resultsin maximum expression in muscle tissue (www.genscript.com).

For the pAAV.tMCK.hSGCB construct, the cDNA was then cloned into aplasmid containing AAV2 ITRs and the cassette included a consensus Kozaksequence (CCACC), an SV40 chimeric intron and a syntheticpolyadenylation site (53 bp). The recombinant tMCK promoter was a giftfrom Dr Xiao Xiao (University of North Carolina). It is a modificationof the previously described CK6 promoter27 and includes a modificationin the enhancer upstream of the promoter region containing transcriptionfactor binding sites. The enhancer is composed of two E-boxes (right andleft). The tMCK promoter modification includes a mutation converting theleft E-box to a right E-box (2R modification) and a 6-bp insertion (S5modification). The pAAV.tMCK.hSGCB vector was constructed by ligation of1040 bp KpnI/XbaI fragment from pUC57-BSG (Genscript Inc.) into theKpnI/XbaI sites of pAAV. tMCK.hSGCA.26

The pAAV.MHCK7.hSGCB vector was constructed by removing the tMCKpromoter and SV40 chimeric intron with NotI/KpnI sites and inserting aPCR amplified fragment containing the MHCK7 promoter and identical SV40chimeric intron with NotI/KpnI sites. MHCK7 is an MCK based promoterwhich utilizes a 206-bp enhancer taken from ˜1.2 kb 5′ of thetranscription start site within the endogenous muscle creatine kinasegene with a proximal promoter (enh358MCK, 584-bp)^(3,12). The MHCK7promoter itself contains this modified CK7 cassette from the MCK familyof genes ligated to a 188-bp α-MyHC (α-myosin heavy chain) enhancer 5′of the CK portion to enhance cardiac expression¹². The creatine kinaseportion of the promoter (CK) is 96% identical between tMCK and MHCK7.Finally, the pAAV.MHCK7.hSGCB vector was constructed by ligation of the960 bp NotI/KpnI MHCK7+Intron fragment from pAAV.MHCK7.DYSF5′DV44 intothe NotI/KpnI sites of pAAV.tMCK.hSGCB (Pozgai et al., Gene Ther. 23:57-66, 2016)

rAAV production. A modified cross-packaging approach, previouslyreported by Rodino-Klapac et al. (J. Trans. Med. 5:45, 2007), was usedto produce the rAAV vector. Here, a triple transfection method withCaPO₄ precipitation in HEK293 cells allows for AAV2 ITRs to be packagedinto a different AAV capsid serotype. (28,29) The production plasmidswere (i) pAAV.tMCK.hSGCB or pAAV.MHCK7.hSGCB, (ii) rep2-caprh.74modified AAV helper plasmids encoding cap serotype 8-like isolate rh.74and (iii) an adenovirus type 5 helper plasmid (pAdhelper) expressingadenovirus E2A, E4 ORF6 and VA I/II RNA genes. Vectors were purified andencapsidated vg titer (utilizing a Prism 7500 Taqman detector system; PEApplied Biosystems, Carlsbad, Calif., USA) was determined as previouslydescribed. 30 The primer and fluorescent probe targeted the tMCKpromoter and were as follows: tMCK forward primer, 5′-ACC CGA GAT GCCTGG TTA TAA TT-3′ (SEQ ID NO: 10); tMCK reverse primer, 5′-TCC ATG GTGTAC AGA GCC TAA GAC-3′ (SEQ ID NO: 11); and tMCK probe, 5′-FAM-CTG CTGCCT GAG CCT GAG CGG TTA C-TAMRA-3′ (SEQ ID NO: 12). The primer andfluorescent probe targeted the MHCK7 promoter and were as follows: MHCK7forward primer, 5′-CCA ACA CCT GCT GCC TCT AAA-3′ (SEQ ID NO: 16); MHCK7reverse primer, 5′-GTC CCC CAC AGC CTT GTT C-3′ (SEQ ID NO: 17); andMHCK7 probe, 5′-FAM-TGG ATC CCC-Zen-TGC ATG CGA AGA TC-3IABKFQ-3′ (SEQID NO: 18).

Intramuscular Gene delivery. For intramuscular injection, mice wereanesthetized and maintained under 1-4% isoflurane (in O²). The anteriorcompartment of the lower left limb of 4- to 6-week-old SGCB^(−/−) micewas cleaned with 95% EtOH then the transverse abdominal (TA) muscle wasinjected with 3×10¹¹ vg of scAAVrh.74.tMCK.hSGCB diluted in saline in a30-μl volume using a 30 gauge ultra-fine insulin syringe. Thecontralateral muscle was left untreated to serve as a control. TA musclefrom both limbs was removed at either 6 (n=9, 4 male, 5 female) or 12(n=6, 4 male, 2 female) weeks post injection to assess gene transferefficiency. In experiments involving 6-month-old mice (n=5, 5 male),treatment consisted of intramuscular injection into the left TA with3×10¹¹ vg scAAVrh.74.tMCK.hSCGB. For isolated limb perfusionexperiments, sgcb^(−/−) mice were perfused at 4 (n=5, 5 male) and 5(n=4, 2 male, 2 female) weeks of age with 5×10¹¹ vg ofscAAVrh.74.tMCK.hSCBB by injection into the femoral artery as previouslydescribed.19 Animals were euthanized and muscles were analyzed 8 weekspost gene transfer.

Systemic Gene Delivery: Systemic delivery was achieved through injectionof vector into the tail vein of sgcb^(−/−) mice. Mice were injected with1×10¹² vg of scAAVrh.74.MHCK7.hSGCB diluted in saline in a 212 μL volumeusing a 30 gauge ultra-fine insulin syringe. Mice were restrained in aholding tube placing the tail back through tail slot to warm it up inorder dilate the blood vessels for ease of injection. After locating theartery down the center line of the tail, the injection was performed inone of the purple/blue lateral veins that run alongside the tail artery.All treated mice were injected at 4-5 weeks of age and euthanized6-months post-injection.

EDL force generation and protection from eccentric contractions. Aphysiological analysis of the EDL muscles from mice treated by isolatedperfusion (ILP) was performed. The EDL muscle from both lower hind limbsof treated mice was dissected at the tendons and subjected to aphysiology protocol to assess function that was previously described byour laboratory and others (19,31) with some adaptations. During theeccentric contraction protocol, a 5% stretch-re-lengthening procedureexecuted between 500 and 700 ms (5% stretch over 100 ms, followed byreturn to optimal length in 100 ms). Following the tetanus and eccentriccontraction protocol, the muscle was removed, wet-weighed, mounted onchuck using gum tragacanth, and then frozen in methyl-butane cooled inliquid nitrogen.

TA force generation and protection from eccentric contractions. Aprotocol to assess functional outcomes in the TA muscle was performed onmuscles extracted from mice treated by IM injection. This TA procedureis outlined in several previous studies.(32,33) After the eccentriccontractions, the mice were then euthanized and the TA muscle wasdissected out, weighed and frozen for analysis. Analysis of the data wasperformed blindly but not randomly.

Immunofluorescence. Cryostat sections (12 μm) were incubated with amonoclonal human beta-sarcoglycan primary antibody (Leica Biosystems,New Castle, UK; Cat. No. NCL-L-b-SARC) at a dilution of 1:50 in a blockbuffer (1×TBS, 10% Goat Serum, 0.1% Tween) for 1 h at room temperaturein a wet chamber. Sections were then washed with TBS three times, eachfor 20 min and re-blocked for 30 min. AlexaFluor 594 conjugated goatanti-mouse secondary IgG1 antibody (Life Technologies, Grand Island,N.Y., USA; Cat. No. A21125) was applied at a 1:250 dilution for 45 min.Sections were washed in TBS three times for 20 min and mounted withVectashield mounting medium (Vector Laboratories, Burlingame, Calif.,USA). Four random ×20 images covering the four different quadrants ofthe muscle section were taken using a Zeiss AxioCam MRCS camera.Percentage of fibers positive for beta-sarcoglycan staining (450% ofmuscle membrane staining intensity) was determined for each image andaveraged for each muscle.

Western blot analysis. Tissue sections from the left treated TA muscleand the right contralateral TA muscle (20-20 micron thick) werecollected into a micro-centrifuge and homogenized with 100 μlhomogenization buffer (125 mM Tris-HCl, 4% SDS, 4 M urea) in thepresence of 1 protease inhibitor cocktail tablet (Roche, Indianapolis,Ind., USA). After homogenization, the samples were centrifuged at 10,000rpm for 10 min at 4° C. Protein was quantified on NanoDrop (ThermoScientific, Waltham, Mass., USA). Protein samples (20 μg) wereelectrophoresed on a 3-8% polyacrylamide Tris-acetate gel (NuPage,Invitrogen, Carlsbad, Calif., USA) for 1 h 5 min at 150 V and thentransferred onto a PVDF membrane (Amersham Biosciences, Piscataway,N.J., USA) for 1 h 15 min at 35 V. The membrane was blocked in 5%non-fat dry milk in TBST for 1 h, and then incubated with a rabbitpolyclonal human beta-sarcoglycan antibody (Novus Biologicals,Littleton, Colo., USA; Cat. No. NBP-1-90300 1:100 or 1:250 dilution) anda 1:5000 of a monoclonal mouse gamma-tubulin antibody (Sigma-Aldrich, StLouis, Mo., USA; Cat. No. T6557) or a 1:5000 dilution of a mousemonoclonal mouse α-actinin antibody (Sigma-Aldrich, St Louis, Mo., USA;Cat. No. A7811). A 1:500 dilution of a rabbit polyclonal mouse cardiactroponin I antibody (Abcam, Cambridge, Mass.; Cat. No. ab47003) and a1:1000 dilution of a rabbit monoclonal mouse vinculin antibody(Invitrogen, Frederick, Md.; Cat. No. 70062) were used. Anti-mouse(Millipore, Billerica, Mass., USA; Cat. No. AP308P) and anti-rabbit(Life Technologies; Cat. No. 656120) secondary-HRP antibodies were usedfor ECL immunodetection.

EBD assay. A dose of 3×10¹⁰ vg of scAAVrh.74.tMCK.hSGCB was delivered to4-week-old sgcb^(−/−) mice to the left TA through an intramuscularinjection. Four weeks post injection, mice were injected in theintraperitoneal cavity on the right side at 5 μl/g body weight of afilter sterilized 10 mg/ml EBD in 1× phosphate buffer solution. Micewere then killed 24 h post injection and tissues were harvested andsectioned. Sections were fixed in cold acetone for 10 min and then theimmunofluorescence protocol was used to stain for humanbeta-sarcoglycan.

Morphometric analysis. Muscle fiber diameters and percentage ofmyofibers with centrally located nuclei were determined from TA and GASmuscles stained with hematoxylin and eosin (H&E). Four random ×20 imagesper section per animal were taken with a Zeiss AxioCam MRCS camera.Centrally nucleated fibers were quantified using the NIH ImageJ software(Bethesda, Md., USA). Fiber diameters were measured as the shortestdiameter through the muscle fiber using Zeiss Axiovision LE4 software(Carl Zeiss Microscopy, Munich, Germany).

Biodistribution qPCR analysis. Taqman quantitative PCR was performed toquantify the number of vector genome copies present in targeted anduntargeted contralateral muscle as well as non-targeted organs aspreviously described.(18,30) A vector-specific primer probe set was usedto amplify a sequence of the intronic region directly downstream fromthe tMCK promoter that is unique and located within thescAAVrh.74.tMCK.hSGCB transgene cassette. The following primers andprobe were used in this study: tMCK and MHCK7 intron Forward Primer5′-GTG AGG CAC TGG GCA GGT AA-3′ (SEQ ID NO: 13); tMCK and MHCK7 intronReverse Primer 5′-ACC TGT GGA GAG AAA GGC AAA G-3′ (SEQ ID NO: 14); andtMCK and MHCK7 intron Probe 5′-6FAM-ATC AAG GTT ACA AGA CAG-GTT TAA GGAGAC CAA TAG AAA-tamra-3′ (IDT) (SEQ ID NO: 15). Copy number is reportedas vector genomes per microgram of genomic DNA.

Immunohistochemistry for immune cell staining. Immunohistochemistry wasused to identify immune cells. Frozen tissue sections on FisherbrandSuperfrost charged microscope slides were incubated with rat anti-mousemonoclonal antibodies using an anti-rat Ig HRP Detection kit (BDPharmagen, San Jose, Calif., USA; Cat: 551013): CD3 (Cat: 555273), CD4(Cat: 550280), CD8 (Cat: 550281) and Mac-3 for macrophages (Cat:550292). All primary antibodies were diluted at 1:20 withphosphate-buffered saline. Positive immune staining was visualized usingDAB chromagen diluted in DAB buffer with Streptavidin-HRP peroxidaseectastain ABC Peroxidase. Ten random ×40 images were taken for eachmuscle and each corresponding stain. The number of mono-nuclear cellswas counted and expressed as total number per mm².

Picrosirius red stain and collagen quantification. Frozen sectionsplaced onto Fisherbrand Superfrost charged microscope slides were fixedin 10% Neutral Buffered Formalin for 5 min, then rinsed in distilledwater. Slides were then incubated in Solution A (Phosphomolydbic acid)from the Picrosirius Red Stain Kit (Polysciences Inc., Warrington, Pa.,USA; Catalog #24901) for 2 min. After a thorough rinse in distilledwater, the slides were placed in Solution B (Direct Red 80/2 46-Trinitrophenol) for 15 min, followed by an additional rinse indistilled water and then incubation in Solution C (0.1 N hydrochlorideacid) for 2 min. Slides were counterstained for 2.5 min with 1% FastGreen in 1% Glacial Acetic Acid from Poly Scientific (Catalog #S2114)using a 1:10 dilution in DI water. Finally, the slides were rinsed againin distilled water, dehydrated in graded ethanol, cleared in xylene andmounted with coverslips using Cytoseal 60 media from Thermo-Scientific(Waltham, Mass., USA; Cat #8310). Images were taken using the AxioVision4.9.1 software (Carl Zeiss Microscopy). For analysis of Sirius redstaining and % collagen quantification, the contrast between the red andthe green colors was enhanced using Adobe Photoshop. The colordeconvolution plugin in the ImageJ software program was selected and theRGB color deconvolution option was used. The Red image includes allconnective tissue from the Sirius Red stain. The Green image includesall muscle from the Fast Green counterstain. Only the Red image and theoriginal image were used. A threshold was then applied to the images toobtain black and white images with areas positive for collagen in blackand negative areas in white. Using the measure function, the area ofcollagen was calculated. The total tissue area was then determined byconverting the originally image to ‘8-bit’ and adjusting the thresholdto 254, which will be one unit below completely saturating the image.The total tissue area was then measured as done previously and totalarea was recorded. The percentage of collagen was then calculated bydividing the area of collagen by the total tissue area. The meanpercentage for each individual was then calculated.

Diaphragm Tetanic Contraction for Functional Assessment: Mice wereeuthanized and the diaphragm was dissected with rib attachments andcentral tendon intact, and placed in K-H buffer as previously describedby Beastrom et al. (Am. J. Pathol. 179: 2464-74, 2011), Rafael-Forney etal. (Circulation 124: 582-8, 2011 and Moorwood e t al. (J. VisualizedExperiments 71:e50036, [year?]) A 2-4 mm wide section of diaphragm wasisolated. Diaphragm strips were tied firmly with braided surgical silk(6/0; Surgical Specialties, Reading, Pa.) at the central tendon, andsutured through a portion of rib bone affixed to the distal end of thestrip. Each muscle was transferred to a water bath filled withoxygenated K-H solution that was maintained at 37° C. The muscles werealigned horizontally and tied directly between a fixed pin and adual-mode force transducer-servomotor (305C; Aurora Scientific, Aurora,Ontario, Canada). Two platinum plate electrodes were positioned in theorgan bath so as to flank the length of the muscle. The muscle wasstretched to optimal length for measurement of twitch contractions, andthen allowed to rest for 10 minutes before initiation of the tetanicprotocol. Once the muscle is stabilized, the muscle is set to an optimallength of 1 g and is subjected to a warm-up which consists of three 1 Hztwitches every 30 seconds followed by three 150 Hz twitches everyminute. After a 3 min rest period, the diaphragm is stimulated at 20,50, 80, 120, 150, 180 Hz, allowing a 2 min rest period between eachstimulus, each with a duration of 250 ms to determine maximum tetanicforce. Muscle length and weight was measured. The force was normalizedfor muscle weight and length.

Cardiac Magnetic Resonance Imaging: Cardiac function was analyzed usinga 9.4T horizontal-bore magnetic resonance imaging (MRI) system and mousevolume coil (Bruker BioSpin, Billerica, Mass., USA). Mice wereanaesthetized with 2.5% isofluorane mixed with carbogen (1 L/min) for 3minutes prior to placement on the imaging bed. Upon placement of mice inimaging apparatus and initiation of imaging, isoflurane/carbogen mixturewas dropped to 1.5% for the remainder of the study. EKG and respirationwere monitored using an MRI-compatible system (Model 1025, Small AnimalInstruments, Stonybrook, N.Y., USA). Gated cardiac short-axis FLASH cineT1-weighted images were acquired over the entire left ventricle (LV) ofthe mouse (TR=8 ms; TE=2.8 ms; □=18o; matrix=256×256; FOV=3.0×3.0 cm;slice thickness=1 mm, nslices=7, up to 20 frames per cardiac cycle). Forimage analysis, the end-diastolic and end-systolic timepoint of eachshort-axis image were identified and the endocardial and epicardialcardiac boundaries were manually traced. The papillary muscles wereexcluded from the endocardial boundary of the LV. From these measuredareas, end-diastolic volume (EDV), end-systolic volume (ESV), strokevolume (SV), cardiac output (CO), ejection fraction (EF), and average LVmass were calculated.

Immunofluorescence: Cryostat sections (12 μm) from the tibialis anterior(TA), gastrocnemius (GAS), quadriceps (QUAD), psoas major (PSOAS),gluteal (GLUT), triceps (TRI), and diaphragm muscles along with theheart were subjected to immunofluorescence staining for the hSGCBtransgene via our previously used protocol as described in Pozgai etal., Gene Therap. 23: 57-66, 2016. Sections were incubated with a mousemonoclonal human beta-sarcoglycan primary antibody (Leica Biosystems,New Castle, UK; Cat. No. NCL-L-b-SARC) at a dilution of 1:100. Fourrandom 20× images covering the four different quadrants of the musclesection were taken using a Zeiss AxioCam MRCS camera. Percentage offibers positive for beta-sarcoglycan staining (>50% of muscle membranestaining) was determined for each image and averaged for each muscle.

Morphometric Analysis: Hematoxylin and eosin (H&E) staining wasperformed on 12 μm thick cryosections of muscle from 7 month old C57BL6WT mice (n=5), sgcb^(−/−) mice (n=5), and rAAV.MHCK7.hSGCB 6 monthtreated sgcb^(−/−) mice (n=5) for analysis. The percentage of myofiberswith central nuclei was determined in the TA, GAS, QUAD, PSOAS, GLUT,TRI, and diaphragm muscles. Additionally, muscle fiber diameters weremeasured in the GAS, PSOAS, and TM muscles. Four random 20× images permuscle per animal were taken with a Zeiss AxioCam MRCS camera. Centrallynucleated fibers were quantified using the NIH ImageJ software and fiberdiameters were measured using Zeiss Axiovision LE4 software.

X-Ray Images: Whole body x-rays were performed on anesthetized 7 monthold C57BL6 WT mice (n=6), untreated sgcb^(−/−) mice (n=6), andrAAV.MHCK7.hSGCB 6 month treated sgcb^(−/−) mice (n=6) using theFaxitron MX-20 digital x-ray system at 26 kV for 3 secs (Faxitron X-RayCorp, Lincolnshire, USA).

Laser Monitoring of Open Field Cage Activity: An open-field activitychamber was used to determine overall activity of experimental mice.Mice at 7 months old from the C57BL6 WT (n=6) and untreated sgcb^(−/−)(n=6) control groups along with the rAAV.MHCK7.hSGCB 6 month treatedsgcb^(−/−) mice (n=6) were subjected to analysis following a previouslydescribed protocol (Kobayashi et al., Nature 456: 511-5, 2008, Beastromet al., Am. J. Pahol. 179: 2464-74, 2011) with several modifications.All mice were tested at the same time of day in the early morning nearthen end of the night cycle when mice are most active. All mice weretested in an isolated room, under dim light and with the same handlereach time. To reduce anxiety and keep behavioral variables at a minimum,which could potentially affect normal activity of the mice andconsequently the results of the assay, the mice tested were notindividually housed (Voikar et al., Genes Brain Behav. 4: 240-52, 2005).Mice were activity monitored using the Photobeam Activity System (SanDiego Instruments, San Diego, Calif.). This system uses a grid ofinvisible infrared light beams that traverse the animal chamber front toback and left to right to monitor the position and movement of the mousewithin an X-Y-Z plane. Activity was recorded for 1 hour cycles at5-minute intervals. Mice were acclimatized to the activity test room foran initial 1 hour session several days prior to beginning dataacquisition. Mice were tested in individual chambers in sets of 4.Testing equipment was cleaned between each use to reduce mousereactionary behavioral variables that could alter our results. Datacollected was converted to a Microsoft Excel worksheet and allcalculations were done within the Excel program. Individual beam breaksfor movement in the X and Y planes were added up for each mouse torepresent total ambulation, and beam breaks in the Z plane were added upto obtain vertical activity within the 1 hour time interval.

Example 1 scAAVrh.74.tMCK.hSGCB Construction and Vector Potency

The transgene cassette containing a codon-optimized full-length humanSCGB cDNA as shown in FIG. 1A was constructed. The cassette includes aconsensus Kozak sequence (CCACC), an SV40 chimeric intron, a syntheticpolyadenylation site, and the muscle-specific tMCK promoter (20) used todrive expression of the cassette. The cassette was packaged into aself-complementary (sc) AAVrh.74 vector that is 93% homologous to AAV8.AAVrh.74 has been shown in mice and non-human primates to be safe andeffective, particularly in crossing the vascular barrier when deliveredto muscle through the circulation.(17, 18, 21) Vector potency wasestablished by intramuscular injection into the left TA muscle in theSgcb-null mouse. Delivery of 3×10¹⁰ vg transduced 70.5±2.5% of musclefibers and 1×10¹¹ vg transduced 89.0±4.0% of muscle fibers, 3 weeks postgene transfer.

Example 2 Intramuscular Delivery of scAAVrh.74.tMCK.hSGCB

Following vector potency, studies were extended to analyze the efficacyof therapy 6 and 12 weeks post gene transfer. As a result of the highlevels of expression following the short 3-week potency study, a dose of3×10¹⁰ vg total was selected for subsequent studies to use the lowesteffective dose. Five-week-old sgcb^(−/−) mice were treated with 3×10¹⁰vg of scAAVrh.74.tMCK.hSCGB intramuscularly to the left transverseabdominal (TA) and β-sarcoglycan expression was demonstrated usingimmunofluorescence in 88.4±4.2% of muscle fibers 6 weeks post injection(n=9), and in 76.5±5.8% of muscle fibers 12 weeks post injection (n=6),and expression was confirmed via western blotting (FIG. 1B).β-Sarcoglycan expression was accompanied by restoration of components ofthe dystrophin-associated protein complex (α-sarcoglycan and dystrophin)(FIG. 1C). Using Evans blue dye (EBD) as a marker for membranepermeability (22, 23) we found all fibers expressing exogenousβ-sarcoglycan were protected from leakage and EBD inclusion (FIG. 1D).Muscle from sgcb^(−/−) mice exhibit a severe muscular dystrophy withcentrally nucleated fibers, frequent muscle fiber necrosis, fibrotictissue and significant fiber size variability represented by bothatrophic and hypertrophic fibers. (3, 4) As seen in FIG. 2A, hematoxylin& eosin staining shows an overall improvement in the dystrophicphenotype of diseased muscle including a reduction in central nuclei(sgcb^(−/−) untreated-76.8±2.3% vs AAV.hSCGB treated-38.86±3.5%;P<0.0001) (FIG. 2C). Normalization of fiber size distribution, with anincrease in the average fiber diameter following treatment was alsoobserved (sgcb^(−/−) untreated-32.6±0.31 μm vs AAV.hSGCBtreated-35.56±0.22 μm; P<0.0001) (FIG. 2D).

The histopathological hallmark of the scgb^(−/−) mouse is fibrosischaracterized by widespread replacement of muscle tissue primarily withcollagens along with other extracellular matrix components such asfibronectin, elastin, laminin and decorin.(14) This replacement ofmuscle tissue by connective tissue challenges the potential value ofgene replacement and may limit the degree of improvement. (24) To testthis, mice treated for 12 weeks were assayed for reduction in fibrosis.The TA muscle was specifically assessed since its inherent degree offibrosis was established in the KO model and because it represents apotential target following vascular ILP gene delivery. Picrosirius redstaining for collagen, types I and III, of TA muscles showed asignificant reduction (52.74%) in the amount of collagen present withinscAAVrh.74.tMCK.hSGCB-treated muscle compared with untreated sgcb^(−/−)mouse muscle (20.7±0.57% vs 43.8±2.3%, AAV.hSGCB treated vs sgcb^(−/−)untreated, respectively; P<0.0001) (FIGS. 2b and e ). Untreatedsgcb^(−/−) muscle from 5-week-old mice at the age of injection had24.05±1.5% collagen deposition, indicating there was a slight (14.0%)reduction in the amount of collagen following the 12 weeks of treatment.

Example 3 Functional Correction in Skeletal Muscle FollowingscAAVrh.74.tMCK.hSGCB Gene Transfer

To determine whether hSGCB gene transfer can improve muscle function, weassessed the functional properties of the TA muscle from sgcb^(−/−) micetreated with scAAVrh.74.tMCK.hSCGB. Following intramuscular delivery of3×10¹⁰ vg of scAAVrh.74.tMCK.hSCGB to the TA of 4-week-old sgcb^(−/−)mice, 6 weeks post treatment the TA muscles were subjected to in situforce measurements (n=4). Treated muscles were compared with untreatedcontralateral muscles and those from C57BL/6 WT mice.scAAVrh.74.tMCK.hSCGB-treated muscle showed significant improvement inboth absolute tetanic force and normalized specific force (FIGS. 3A andB). Treated muscles had an average absolute force of 1436.9±199.5 mNcompared with 770.9±118.3 mN for untreated sgcb^(−/−) controls (P<0.01).Similarly, treated TA muscles produced an average specific force of254.01±6.9 mN/mm² and untreated muscles produced 124.2±13.9 mN/mm² offorce (P<0.01). Finally, muscles treated with scAAVrh.74.tMCK.hSCGBshowed greater resistance to contraction-induced injury compared withthe untreated control muscles (FIG. 3C). Treated TA muscles lost34.0±5.1% of force from that produced after the first contractionwhereas untreated diseased muscle lost 54.1±3.8% (P<0.01) of forcefollowing the eccentric contraction protocol. These data show that hSGCBgene transfer does provide a functional benefit to diseased muscledeficient for β-sarcoglycan.

Example 4 Treatment of Aged Muscle with scAAVrh.74.tMCK.hSGCB

Studies of disease progression in this mouse model of LGMD2E have shownthat although the most severe tissue remodeling in muscle occurs between6 and 20 weeks, the histopathology of the muscle continues to worsenwith age, resembling the disease progression in patients.(3, 4, 14)Consequently, to mimic a clinical setting where treatment would occur atan older age with more advanced muscle deterioration and endomysialfibrosis, we treated 6-month-old sgcb^(−/−) mice (n=5) intramuscularlyin the TA with 3×10¹⁰ vg of scAAVrh.74.tMCK.hSCGB. Following 12 weeks oftreatment, at 9 months of age, 80.1±4.8% of muscle fibers weretransduced (FIG. 4A). Picrosirius red stain for collagen types I and IIIshowed a 42.2% reduction in the amount of collagen present in treatedmice compared with untreated sgcb^(−/−) mouse muscle (AAV.hSGCBtreated-20.0±0.80% vs sgcb^(−/−) untreated-34.6±1.4%, P<0.0001) (FIGS.4B and C). At the age of treatment, 6-month-old sgcb^(−/−) mice have30.8±2.0% collagen deposition (n=4, 4 male); thus, these resultsindicate that scAAVrh.74.tMCK.hSCGB treatment not only prevents, butalso has the potential to reverse existing fibrosis.

Example 5 ILP of scAAVrh.74.tMCK.hSGCB in sgcb−/− Mice

The ability to target multiple muscles in one limb allows for a moreclinically relevant delivery method for translation to LGMD2E patients.Delivery of 5×10¹¹ vg of scAAVrh.74.tMCK.hSGCB by ILP in 4- to6-week-old sgcb^(−/−) mice (n=9, 7 male, 2 female) was analyzed 2 monthspost gene transfer. β-Sarcoglycan expression reached 91.8±4.7% of fibersin the gastrocnemius (GAS) muscle and 90.6±2.8% in TA (FIG. 5A). ILPdelivery of scAAVrh.74.tMCK.hSGCB resulted in significant protectionfrom eccentric contraction-induced injury (P<0.05), that was notdifferent from WT, compared with untreated contralateral muscles (FIG.5C). Vascular delivery also restored muscle histopathological parameters(FIG. 5B). Central nuclei were decreased in the TA (sgcb^(−/−)untreated-76.9±2.8% vs AAV.hSGCB treated-23.2±5.7%, P<0.001) and GAS(sgcb^(−/−) untreated-78.2±2.4% vs AAV.hSGCB treated-16.8±6.6%,P<0.001). Gene transfer also led to an increase in the average fibersize in the TA (sgcb^(−/−) untreated-30.53±0.52 μm vs AAV.hSGCBtreated-41.9±0.46 μm; P<0.0001) and GAS (sgcb^(−/−) untreated-38.9±0.37μm vs AAV.hSGCB treated-33.3±0.44 μm; P<0.0001), with normalization offiber diameter distribution. a substantial decrease (˜60%) in the numberof CD3 cells, CD4 cells and macrophages (Table 1) was observed.

TABLE 1 Immune response in scAAVrh.74.tMCK.hSGCB ILP-treated miceUninjected Treated Left Untreated Right SGCB −/− Cell type TA cells/mm²TA cells/mm² TA cells/mm² CD3 15.6 ± 3.2 37.85 ± 6.2  29.8 ± 1.7 CD420.9 ± 4.7 58.1 ± 2.9 49.0 ± 0.8 CD8  8.2 ± 1.8 12.7 ± 2.4 15.5 ± 5.8Macrophage 28.2 ± 5.0 75.2 ± 5.6 100.2 ± 5.9  Abbreviations: ANOVAanalysis of variance; ILP, isolated-limb perfusion; SGCB, β-sarcoglycan;TA, tibialis anterior. Quantification of immune cells present inuninjected SGCB −/− mice, and scAAVrh.74.tMCK.hSGCB treated anduntreated muscle. Data shown are following ILP delivery of virus andrepresent the mean number of cells/mm² ± s.e.m. n = 8 per group. Aone-way ANOVA used to compare values from the three different cohorts.Levels of immune cells were decreased with a statistically significantdifference (P < 0.01) between the treated left TA and untreated right TAand/or the treated left TA and uninjected TA in all stains except forCD8.

Picrosirius red staining of TA and GAS muscles also showed a significantreduction in the amount of collagen compared with untreated sgcb^(−/−)muscle following vascular delivery (FIG. 6a ). Collagen levels in the TAwere reduced to 21.6±1.3% in treated muscle compared with 40.2±1.5% inuntreated sgcb^(−/−) mice at the age of end point (P<0.0001). Asindicated previously, sgcb^(−/−) mice at the age of injection presentedwith 24.1±1.5% collagen in TA muscle, indicating again a slightreduction (10.0%) in collagen deposition following 8 weeks of treatment.Similarly, staining of the GAS muscle showed that treated mice had22.9±0.99% collagen compared with 37.9±1.3% in untreated sgcb^(−/−) miceat the end point (P<0.0001). Qualitative PCR was performed to detectcollagen transcript levels in muscle, which correlate with the resultsof the Sirius red staining. Taken together, these data show thatAAV-mediated delivery of human β-sarcoglycan reduces muscle fibrosis,improves muscle function and reverses dystrophic pathology of sgcb^(−/−)diseased muscle.

Example 6 Safety and Biodistribution of rAAVrh.74.tMCK.hSGCB

Initially, normal WT mice injected with 3×10₁₀ vg ofscAAVrh.74.tMCK.hSGCB intramuscularly into the TA showed no signs oftoxicity by H&E stain indicating no adverse effects due to the virus.Following the ILP vascular delivery of 5×10¹¹ vg total dose ofscAAVrh.74.tMCK.hSGCB as described in the previous section, the safetywas assessed in a small group of mice in this cohort (n=4). First,targeted muscles with significant gene expression were analyzed, as wellas off target organs including heart, lung, liver, kidney, spleen,gonads and diaphragm histologically. Paraffin sections were formallyreviewed by a veterinary pathologist and there was no evidence oftoxicity in any organ noted (data not shown). Protein expression andvector biodistribution were also assessed in all of the above tissuesand organs with western blotting and qPCR, respectively. Vector genomecopies were detected in all organs tested; however, no proteinexpression was detected in any sample other than treated muscle (FIG.7). Finally, an analysis of wet weights of treated and untreated muscleshows no significant difference or trend when comparing the averageweights from either cohort (data not shown). These data provide evidencethat the muscle-specific tMCK promoter restricted expression to skeletalmuscle and the vector is non-toxic.

Example 7 Histological and Functional Deficits in the Heart andDiaphragm of SGCB−/− Mice

WT and 7 month old SGCB−/− mice (n=6 per strain) that were untreatedwere analyzed by cardiac MRI and diaphragm physiology to look fordeficits. Following these analyses the animals were sacrificed andevaluated for histopathology (FIG. 8). Trichrome staining showedextensive fibrosis (red staining) in both the diaphragm (FIG. 8A) andheart (FIG. 8C). This was accompanied by functional deficits of specificforce in the diaphragm (116.24 mN/mm² SGCB−/− vs. 236.67 mN/mm² WT, FIG.8B) and significant deficit in ejection fraction measured by MRI (WT,78% vs. SGCB−/− 65%, FIG. 8D).

Example 8 scAAVrh.74.MHCK7.hSGCB Construction and Vector Potency

The transgene cassette containing a codon-optimized full-length humanSCGB cDNA as shown in FIG. 9A was constructed. The cassette includes aconsensus Kozak sequence (CCACC), an SV40 chimeric intron, a syntheticpolyadenylation site, and the muscle-specific MHCK7 used to driveexpression of the cassette. This is an MCK based promoter which utilizesa 206-bp enhancer taken from ˜1.2 kb 5′ of the transcription start sitewithin the endogenous muscle creatine kinase gene with a proximalpromoter (enh358MCK, 584-bp)^(3,12). The cassette was packaged into aself-complementary (sc) AAVrh.74 vector that is 93% homologous to AAV8.AAVrh.74 has been shown in mice and non-human primates to be safe andeffective, particularly in crossing the vascular barrier when deliveredto muscle through the circulation.(17, 18, 21) Vector potency wasestablished by intramuscular injection into the left TA muscle in theSgcb-null mouse. Delivery of 3×10¹⁰ vg transduced >90% of muscle fibers4 weeks post gene transfer.

Example 9 Systemic Delivery of scAAV.MHCK7.hSGCB

We delivered vector through a tail vein injection to 14 SGCB−/− mice ata dose of 1×10¹² vg total dose (5×10¹³ vg/kg) to assess transgeneexpression and efficacy of our vector when delivered systemically at along-term time point of 6 months. Mice were injected at 4 weeks of ageand a full necropsy was performed at 6 months post-injection (1 mousewas taken down at 1 month and 2 mice were taken down at 4 months asintermediate assessments for expression). All skeletal muscles discussedabove along with the diaphragm and heart were extracted for analysis.Organs were also removed for toxicology and biodistribution analysis.Immunofluorescence staining for human beta-sarcoglycan was used todetermine hSGCB transgene expression in 5 limb muscles, both left andright, in additional to the diaphragm and heart of 6 of the KO micegiven a systemic injection of hSGCB vector. These muscles included theTA, gastrocnemius (GAS), quadriceps (QUAD), gluteal (GLUT) (not shown),psoas major (PSOAS), and triceps (TRI) (FIG. 10). A qualitative analysisof heart tissue was also used to assess the relative level of transgeneexpression in cardiac muscle upon delivery.

Four 20× images were taken of each muscle and the percent of hSGCBpositive fibers was determined for each image resulting in the averagepercent transduction for each muscle from each mouse. The results shownin FIG. 10 and FIG. 11 demonstrate ≥98% transduction in all musclesanalyzed including the diaphragm and heart. Mice deficient forβ-sarcoglycan were completely absent of the protein when analyzed byimmunofluorescence. The therapeutic dose of 1×10¹² vg total doseresulted in an average of 97.96±0.36% (±SEM) vector transduction acrossall skeletal muscles including the diaphragm, and approximately 95% orgreater in cardiac muscle (data not shown).

Example 10 Long-Term Systemic Delivery of scAAVrh.74.MHCK7.hSGCB inSGCB^(−/−) Mice

To build upon the results of the one-month potency assay described inExample 9, longer-term (6-month duration) systemic delivery of theβ-sarcoglycan transgene cassette to sgcb^(−/−) mice was investigated.Four-to-five week old sgcb^(−/−) mice were treated with 1×10¹² vg totaldose scAAVrh.74.MHCK7.hSGCB intravenously in the tail vein (n=5). Micewere necropsied 6 months post-injection and hSGCB transgene expressionwas demonstrated using immunofluorescence in six skeletal muscles, bothleft and right, in addition to the diaphragm and heart of all treatedmice. Skeletal muscles analyzed included the TA, GAS, QUAD, gluteal(GLUT), PSOAS, and TRI. Average hSGCB expression resulting from systemicdelivery in treated mice was 98.13±0.31% (±SEM) across all skeletalmuscles including the diaphragm, with expression in the heartexceeding >95%. Representative images are shown in FIG. 12b . Theexpression levels in each individual muscle type averaged from alltreated mice are shown in Table 2. Western blotting in FIG. 12c confirmstransgene expression in all muscles. The expression values in Table 2are presented for various muscles as the average of left and rightmuscles from systemically injected mice (n=5). Values indicated asAVG±SEM. In addition, quantification of hSGCB transgene expression inhearts from treated mice via western blotting and densitometry indicateoverexpression of hSGCB up to 72.0% above BL6 WT levels of expression(FIG. 12d ), correlating to the high levels quantified in skeletalmuscle.

TABLE 2 β-sarcoglycan Immunofluorescence Expression Dose % FibersDelivery (vg Total Endpoint Expressing Muscle Route Dose) (Months) SGCBTA IV 1e12 6 98.88 ± 0.55 GAS IV 1e12 6 98.24 ± 0.82 QD IV 1e12 6 99.32± 0.19 GLUT IV 1e12 6 97.50 ± 0.39 PSOAS IV 1e12 6 98.75 ± 0.23 TRI IV1e12 6 97.21 ± 1.35 Diaphragm IV 1e12 6 97.00 ± 1.26 Heart IV 1e12 6≥95%

An important characteristic of sgcb^(−/−) muscle described in previousreports (Araishi et al, Hum. Mol. Genet 8: 1589-98, 1999, Durbeej etal., Mol. Cell. 5:141-51, 2000) and illustrated by the hematoxylin &eosin staining of the GAS and diaphragm in FIG. 13a is severe dystrophicpathology including central nucleation, necrosis, inflammatoryinfiltration, and fibrosis. Gene transfer significantly improved thispathology, alleviating many of these dystrophic features (FIG. 13a ).Quantification of histological parameters showed a significant reductionin central nucleation in the various skeletal muscles analyzed as aresult of gene transfer (FIG. 13b ). With the expected low levels ofcentral nucleation in BL6 WT mice across all muscles averaging1.89±0.39%, as note here, taking into account all muscles analyzed, anaverage of 66.85±1.86% central nuclei in untreated sgcb^(−/−) micecompared to 36.30±5.16% in AAV.MHCK7.hSGCB treated sgcb^(−/−) muscle(p<0.0001) Table 3 below provides central nuclei counts and fiberdiameters given for various muscles as the average (±SEM) of left andright muscles from BL6 WT, sgcb^(−/−), and systemically injected mice(n=5 per group). Of note, the most significant wave ofdegeneration/regeneration occurs at 3 weeks in sgcb^(−/−) muscleindicated by centrally placed nuclei. Animals were treated followingthis insult and therefore a complete reversal of centralized nuclei wasnot anticipated. A more in depth analysis of muscle histopathologyrevealed a normalization of fiber size distribution accompanied by anincrease in average fiber diameter in diseased mice treated with vectorcompared with untreated sgcb−/− mice in all three muscles examined (GAS:sgcb−/− untreated—28.37±0.23 μm vs. AAV.hSGCB treated—36.04±0.17 μm;p<0.0001) (PSOAS: sgcb−/− untreated—24.75±0.23 μm vs. AAV.hSGCBtreated—38.43±0.28 μm; p<0.0001) (TRI: sgcb^(−/−) untreated—28±0.31 μmvs. AAV.hSGCB treated—35.56±0.22 μm; p<0.0001) (FIGS. 13c, 13d , Table3).

TABLE 3 Analysis of Percent Central Nucleation Dose % Central CombinedFiber Diameter (vg Total Nuclei Avg % CN μm Animal Group Dose) Muscle(Avg ± SEM) (±SEM) (Avg ± SEM) C57BL6 WT N/A TA  1.78 ± 0.86  1.89 ±0.39 N/A GAS  0.83 ± 0.41 39.69 ± 0.18 QD  0.98 ± 0.31 N/A GLUT  2.50 ±0.68 N/A PSOAS  1.26 ± 0.28 40.96 ± 0.22 TRI  2.13 ± 0.36 41.53 ± 0.24DIA  3.75 ± 1.30 N/A Sgcb^(−/−) N/A TA 70.45 ± 3.04 66.85 ± 1.86 N/A GAS67.26 ± 1.81 28.37 ± 0.23 QD 63.57 ± 2.09 N/A GLUT 61.34 ± 2.05 N/APSOAS 62.73 ± 5.20 24.75 ± 0.22 TRI 67.11 ± 2.83 28.74 ± 0.22 DIA 75.47± 3.79 N/A AAV.MHCK7.hSGCB 1.00E+12 TA 43.85 ± 3.89 36.30 ± 5.16 N/ATreated GAS 38.71 ± 3.50 36.04 ± 0.18 QD 46.10 ± 6.26 N/A GLUT 42.11 ±5.48 N/A PSOAS 21.00 ± 4.69 38.43 ± 0.28 TRI 48.39 ± 6.20 39.92 ± 0.27DIA 11.59 ± 2.08 N/A

Due to the significant role fibrosis plays in the pathogenesis of LGMD2Eand effectiveness of therapies, it was critical to demonstrate the sameefficacy in reducing fibrosis. That was saw with localized β-sarcoglycangene transfer. now following systemic delivery ofscAAVrh.74.MHCK7.hSGCB. Using the Picrosirius red stain for collagentypes I and III, we analyzed the levels of collagen in the gastrocnemiusand diaphragm muscles was analyzed in 7 month old BL6 WT mice (n=4),untreated sgcb^(−/−) mice (n=4), and treated sgcb^(−/−) mice (n=5) 6months post-injection. Treated muscles displayed significantly lesscollagen deposition compared to untreated sgcb^(−/−) muscles (FIG. 14a). Vector transduced GAS muscle contained 17.55±0.59% collagen comparedto 43.55±3.33% collagen in untreated sgcb−/− GAS muscles (p<0.0001).Furthermore, treated diaphragm muscle exhibited 21.67±1.09% collagencompared to 44.05±2.39% in untreated sgcb−/− muscle (p<0.0001) (FIG. 14b) demonstrating the ability of hSGCB gene transfer to mitigate thefibrotic component of the LGMD2E phenotype.

Example 11 Restoration of Diaphragm Function Following Systemic Delivery

To determine whether hSGCB gene transfer can improve muscle function, weassessed the functional properties of the diaphragm muscle fromSGCB^(−/−) mice treated with scAAVrh.74.MHCK7.hSCGB (see Griffin et al.for methods). A functional deficit in diaphragms of SGCB−/− mice wasfirst established. KO diaphragms demonstrated a 50.9% reduced specificforce output (116.24 mN/mm²) compared to BL6 WT mice (116.24 mN/mm² vs.236.67 mN/mm²) and greater loss of force following a rigorous fatigueprotocol (23% loss in SGCB^(−/−); 7% loss in BL6 WT). Tail vein deliveryof scAAVrh.74.MHCK7.hSGCB resulting in nearly 100% hSGCB expression inthe diaphragm lead to restoration of diaphragm function with specificforce output improved to 226.07 mN/mm² and a greater resistance tofatigue with only a 12% loss of force (n=5) (FIG. 15).

Example 12 Delivery of scAAVrh.74.CMV.miR29C Reduces Fibrosis in SGCB−/−Mice

The extensive fibrosis we identified in both skeletal muscle (FIGS. 2,4, and 6) as well as the heart and diaphragm (FIG. 8) demonstrated aneed to treat collagen deposition (fibrosis) in LGMD2E. We previouslyfound that Mir29C was most severely reduced (of Mir29A, B, and C) inDuchenne muscular dystrophy. He hypothesized that Mir-29C would also bereduced in Beta-sarcoglycan deficient mice (a mouse model for LGMD2E).We proved this to be true (FIG. 15). Mir29C levels were decreased,fibrosis (collagen) levels were increased, and three components offibrosis (Co1A, Col3A, and Fbn) were increased at the RNA level. To testwhether we could prevent fibrosis with Mir29C, The gene therapy vectorscrAAVrh.74.CMV.miR29c (3×10¹¹ vgs) was injected into the tibialisanterior muscle of 4 week old SGCB−/− mice (n=5). ThescrAAVrh.74.CMV.miR29c is shown in FIG. 16 and described in U.S.Provisional Application No. 62/323,163, the disclosure of which isincorporated herein by reference in its entirety. Following 2 months oftreatment with AAVrh.74.CMV.miR29C, TA muscles were harvested fromtreated and control SGCB−/− mice and WT mice and analyzed for fibrosis(collagen levels) (n=5 per group). Using sirius red staining andquantification, collagen levels were reduced following treatment (seeFIG. 17). Transcript levels of Col1A, Col3A, and Fbn were normalized andmuscle fiber size was increased. Representative images of scanned fullsections of untreated and AAVrh.74.CMV.miR29C treated tibialis anteriormuscles stained with Sirius Red which stains for collagen 1 and 3 areshown in FIG. 118. This demonstrates proof of principle thatscAAVrh.74.CMV.miR29C reduces fibrosis in SGCB−/− mice and could be usedin combination with gene replacement with scAAVrh.74.tMCK.hSGCB orscAAVrh.74.MHCK7.hSGCB.

Example 13 Intravenous Gene Transfer to SGCB−/− Mice ReducesKyphoscoliosis of Thoracic Spine

Degeneration of torso muscles due to the worsening histopathology inpatients suffering from LGMD2E patients can be attributed to kyphosis.Kyphoscoliosis of the thoracic spine due to weakening of musclessupporting the spinal column can result in the diaphragm being pushedforward, further compromising lung capacity and diaphragm function. As aresult of the severity of the phenotype in the sgcb^(−/−) mouse with thegross anatomical appearance of kyphoscoliosis, full body x-rayradiography was used to determine the degree of kyphosis in 7-month oldBL6 WT mice (n=6), sgcb^(−/−) mice (n=6), and treated sgcb−/− mice 6months post-injection (n=6). The kyphotic index (KI) score determines aquantitative value for the level of kyphoscoliosis (Laws et al. J. Appl.Physiol. 97: 1970-7, 2004). As depicted in the WT panel in FIG. 19a ,the KI score is a ratio of length from forelimb to hindlimb compared tothe length of the midline to the apex of the curvature in the spine.While sgcb^(−/−) mice present with a severely curved spine and lower KIscore of 3.64±0.16 (n=6), BL6 WT mice have a significantly straighterspine resulting in a higher KI score of 6.01±0.41 (n=6) (p<0.01) (FIG.19b ). Treated sgcb^(−/−) mice exhibit a significant reduction in thedegree of kyphosis in the spine with an increase in the KI score to5.39±0.58 (n=6) (p<0.05) (FIG. 19b ). These data indicated thatintravenous delivery of scAAVrh.74.MHCK7.hSGCB is beneficial for theoverall integrity of the spine and can alleviate the kyphosis and jointcontractures present in the disease. This data demonstrated thealleviation of kyphosis and increased physical activity in sgcb^(−/−)mice following systemic delivery of the rAAV vector of the invention.This data is additional evidence that the gene therapy of the inventionimproves the quality of life for LGMD2E patients.

Example 14 Assessment of Cardiomyopathy

The histological destruction of limb and diaphragm muscle is alsodetected in the myocardium of 7 month old sgcb^(−/−) mice particularlywith the presence of myocardial necrosis and fibrosis as evident by H&Eand picrosirius red staining (FIG. 20a ). The presentation of impairedheart function often in the form of dilated cardiomyopathy with reducedcardiac output and lower ejection fraction (Semplicini et al., Neurology84: 1772-81, 2015, Fanin et al., Neuromuscul Disorder 13:303-9, 2003).Cardiac magnetic resonance imaging (MRI), was used to evaluate severalfunctional parameters of the heart in order to establish functionaldeficits in the myocardium of sgcb^(−/−) mice compared to BL6 WT mice touse as a functional outcome measure. Imaging of control mice at 7 monthsof age showed a reduction of 29.4% in stroke volume from 0.041±0.0019 mLin sgcb^(−/−) hearts to 0.029±0.0024 mL in BL6 WT hearts (p<0.01), a31.7% lower cardiac output from 14.70±0.74 mL/min in sgcb^(−/−) heartsto 12.72±0.97 mL/min in BL6 WT hearts, and finally a 14.3% lowerejection fraction, 66.21±3.83% in sgcb^(−/−) hearts compared to76.90±1.67% in BL6 WT hearts (p<0.05) (FIG. 20b ). This indicates amodest decline in overall cardiac function at this age and a trendtowards the development of cardiomyopathy. Restoring hSGCB expression inhearts of KO mice through systemic delivery partially corrected thesedeficits, improving stroke volume to 0.032±0.0027 mL, cardiac output to14.66±0.75 mL/min, and ejection fraction to 68.16±2.31% (FIG. 19b ). Asa correlate to the histological and functional disruption of cardiactissue reported here, western blotting for cardiac troponin I (cTrpI)expression, an important regulator of cardiac function and an indicator(biomarker) of cardiac damage, is reduced in diseased sgcb^(−/−) heartsto 60.38% of the levels seen in BL6 WT mice (FIG. 20c ). Levels of cTrpIare restored following treatment to levels of 35.80% of the expressionseen in WT hearts (FIG. 20d ).

Example 15 Functional Restoration in Diaphragm Muscle with Increase inPhysical Activity

The significant involvement of diaphragm dysfunction and respiratoryfailure in LGMD2E mandate functional benefit to the diaphragm essentialfor validation of clinical systemic therapy. With the use of an ex vivoexperimental protocol on strips taken from diaphragm muscle, it wasassessed whether restoring β-sarcoglycan provides a functional benefitto this severely compromised muscle. In accordance with the significanthistopathology identified in 7 month old diaphragms from diseased mice,sgcb^(−/)− diaphragms (n=4) exhibited a functional deficit with asignificant (51%) reduction in specific force output compared to BL6 WTmice (n=5) (116.24±10.49 mN/mm2 vs. 236.67±15.87 mN/mm², respectively,p<0.001), as well as a greater loss of force from that produced afterthe first contraction following a rigorous fatigue protocol (23±1.0%loss in sgcb^(−/−); 7.0±3.0% loss in BL6 WT, p<0.05) (FIG. 6a ). Sixmonths following tail vein delivery of scAAVrh.74.MHCK7.hSGCB, adramatic improvement in specific force output was observed. The specificforce output increased to 226.07±27.12 mN/mm² (n=5) (p<0.05 compared tosgcb^(−/−)) and better protection of the muscle from repeated fatiguewas observed with only a 12.0±4.0% loss of force (p<0.05 compared tosgcb^(−/−)) (FIG. 21a ). Overall, these data support our previousfindings in the TA muscle and show that restoring β-sarcoglycan providesfunctional recovery in diaphragm muscle.

Symptoms of increased fatigue and reduced overall activity arefrequently reported in many neuromuscular diseases, partially attributedto the occurrence of kyphosis. As a result and taking into account thephenotype of LGMD2E, it was hypothesized that KO mice would naturally beless active compared to healthy WT mice, and moreover systemic deliveryof rAAV.MHCK7.hSGCB to sgcb^(−/−) mice would result in more physicallyactive mice. In order to test this hypothesis and additional potentialfunctional benefits of gene transfer, a laser-monitoring of open-fieldcage activity protocol similar to that described in Kobayashi et al.,Nature 456: 511-5, 2008 and Beastrom et al., Am. J. Pathol. 179:2464-74, 2011, was performed on all groups of mice. The graphs in FIG.21b depict a significant decrease (55.5%) in KO mice compared to WT, inboth total ambulation (horizontal movement in the x and y planes) andhindlimb vertical rearing. The average number of horizontal ambulatorylaser beam breaks over a 1 hour period in WT mice was 7355±400.8 (n=6)compared to 3271±483.8 (n=6) in KO mice (p<0.0001). Furthermore, theaverage number of vertical rearing beam breaks recorded in WT mice was626.7±53.76 as opposed to 264.5±63.36 in KO mice (p<0.01) (FIG. 21b ).In accordance with the initial hypothesis, rAAV.MHCK7.hSGCB treated micewere visibly more active compared to KO which was illustrated in thequantification of activity, where total ambulation increased by 22% to5143±293.2 beam breaks (p<0.05) and hind limb vertical rearing increaseddramatically by 77% to 615.3±95.93 beam breaks (p<0.05) in treated mice(n=6) (FIG. 21b ).

Example 16 Safety and Biodistribution Analysis of rAAVrh.74.MHCK7.hSGCB

Potential toxicity or safety concerns of hSGCB gene therapy was assessedin sgcb−/− mice at 6 months following systemic delivery ofscAAVrh.74.MHCK7.hSGCB at 1.0×1012 vg total dose (5×1013 vg/kg). Vectorbiodistribution and off-target transgene expression were analyzed ontissue samples (TA, TRI, diaphragm, heart, gonad, lungs, kidney, liver,and spleen) from vector dosed sgcb^(−/−) animals using qPCR and Westernblotting, respectively. Using vector specific primer probe sets,MHCK7.hSGCB vector genomes were detected at varying levels in allcollected tissues. As expected, the highest levels were seen in theliver as well as skeletal muscle and the heart, indicating that the testarticle was efficiently delivered into all intended muscles of vectordosed mice (FIG. 22a ). Furthermore, western blotting to detect hSGCBprotein expression confirmed the functionality of the muscle specificMHCK7 promoter and the expression of transgene restricted to cardiac andskeletal muscle. Beta-sarcoglycan protein expression was observed invarying amounts in all skeletal muscle samples as well as heart samples,and importantly was not detected in any non-muscle tissue (FIG. 22b ),supported by the fact that beta-sarcoglycan is known to be a musclespecific protein. Finally, hematoxylin & eosin staining was performed oncryosections of muscle tissue and all offsite organs harvested from fivesgcb^(−/−) mice along with five C57BL6 WT mice treated systemically withour vector at the therapeutic dose used in this study. These sectionswere then formally reviewed for toxicity by a veterinary pathologist andno adverse effects were detected in any sample from any of the mice.Taken together, these data indicate that this test article was welltolerated by the test animals.

The fact that such high levels of transduction in all muscles throughoutthe body was achieved with no adverse effects using a relatively lowdose (1×10¹² vg total dose; 5×10¹³ vg/kg) provides great promise fortranslation to LGMD2E patients. From a clinical perspective, the doseused in the experiments described herein is much lower than the doseused for systemic delivery of an SMN1 expressing AAV therapy deliveredto babies with SMA, which is currently in clinical trial (Mendell etal., Mol. Ther. 24: S190, 2016). The highly efficient restoration ofβ-sarcoglycan expression using the MHCK7 promoter accompanied withfunctional benefits is very encouraging at dosing levels that could beapplied clinically, and given the high incidence of heart involvement inthe β-sarcoglycan deficiency in the LGMD2E patients, systemic deliveryprovides a great benefit to these patients.

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What is claimed is:
 1. A recombinant AAV vector comprising apolynucleotide sequence encoding β-sarcoglycan.
 2. The recombinant AAVvector of claim 1 wherein the polynucleotide sequence encodingβ-sarcoglycan comprises a nucleotide sequence at least 95% identical toSEQ ID NO:
 1. 3. The recombinant AAV vector of claim 1, wherein thepolynucleotide sequence encoding β-sarcoglycan comprises the nucleotidesequence set forth in SEQ ID NO:
 1. 4. The recombinant AAV vector of anyone of claims 1-3, wherein the vector is of the serotype AAV1, AAV2,AAV4, AAV5, AAV6, AAV7, AAV8, AAV9, AAV10, AAV11, AAV12, AAV13 or AAVrh.74.
 5. The recombinant AAV vector of any one of claims 1-4, whereinthe polynucleotide sequence is operably linked to a muscle-specificcontrol element.
 6. The recombinant AAV vector of claim 5, wherein themuscle-specific control element is human skeletal actin gene element,cardiac actin gene element, myocyte-specific enhancer binding factormef, muscle creatine kinase (MCK), truncated MCK (tMCK), myosin heavychain (MHC), MHCK7, C5-12, murine creatine kinase enhancer element,skeletal fast-twitch troponin c gene element, slow-twitch cardiactroponin c gene element, the slow-twitch troponin i gene element,hypozia-inducible nuclear factors, steroid-inducible element orglucocorticoid response element (gre).
 7. The recombinant AAV vector ofclaim 6, wherein the muscle-specific control element is truncated MCK(tMCK).
 8. The recombinant AAV vector of claim 6, wherein themuscle-specific control element is MHCK7.
 9. The recombinant AAV vectorof any of claims 1-8 comprising the nucleotide sequence set forth in SEQID NO: 3
 10. The recombinant AAV vector of any of claims 1-8 comprisingthe nucleotide sequence set forth in SEQ ID NO:
 5. 11. A compositioncomprising the recombinant AAV vector of any one of claims 1-10.
 12. Amethod of treating muscular dystrophy in a subject comprisingadministering to the subject a therapeutically effective amount of therecombinant AAV vector of any one of claims 1-10 or the composition ofclaim
 11. 13. A method of increasing muscular force and/or muscle massin a mammalian subject suffering from muscular dystrophy comprisingadministering to the subject a therapeutically effective amount of therecombinant AAV vector of any one of claims 1-10 or the composition ofclaim
 11. 14. A method of reducing fibrosis in a subject suffering frommuscular dystrophy comprising administering to the subject atherapeutically effective amount of the recombinant AAV vector of anyone of claims 1-10 or the composition of claim
 11. 15. A method ofreducing contraction-induced injury in a subject suffering from musculardystrophy comprising administering to the subject a therapeuticallyeffective amount of the recombinant AAV vector of any one of claims 1-10or the composition of claim
 11. 16. A method of treatingβ-sarcoglycanopathy in a subject comprising administering to the subjecta therapeutically effective amount of the recombinant AAV vector of anyone of claims 1-10 or the composition of claim
 11. 17. The method ofclaim any one of claims 12-16, wherein the subject is suffering fromlimb-girdle muscular dystrophy.
 18. The method of any one of claims12-17, wherein the recombinant AAV vector or the composition isadministered by intramuscular injection or intravenous injection. 19.The method of any one of claims 12-17, wherein the recombinant AAVvector or the composition is administered systemically.
 20. The methodof claim 19, where the recombinant AAV vector or the composition isparentally administration by injection, infusion or implantation. 21.The method of any one of claims 12-20, further comprising administeringa second recombinant AAV vector comprising a polynucleotide sequencecomprising miR29C.
 22. The method of claim 21, wherein the secondrecombinant vector comprises the nucleotide sequence set forth in SEQ IDNO: 9 or the nucleotide sequence set forth in SEQ ID NO:
 8. 23. Themethod of claim 21 or 22 wherein the second recombinant AAV vector isadministered by intramuscular injection or intravenous injection.
 24. Acomposition comprising the recombinant AAV vector of any one of claims1-10 for reducing fibrosis in a mammalian subject in need thereof. 25.The composition of claim 24, wherein the subject is suffering frommuscular dystrophy.
 26. A composition comprising the recombinant AAVvector of any one of claims 1-10 for treating a β-sarcoglycanopathy in amammalian subject in need thereof.
 27. The composition of claim 26,wherein the subject is suffering from muscular dystrophy.
 28. Acomposition comprising the recombinant AAV vector of any one of claims1-10 for increasing muscular force in a mammalian subject suffering frommuscular dystrophy.
 29. A composition comprising the recombinant AAVvector of any one of claims 1-10 for treatment of muscular dystrophy.30. The composition of any one of claims 24-29, wherein the musculardystrophy is limb-girdle muscular dystrophy.
 31. The composition of anyone of claims 24-30 further comprising a second recombinant AAV vectorcomprising the miR-29 nucleotide sequence.
 32. The composition of claim31 wherein the second rAAV comprises wherein the second recombinantvector comprises the nucleotide sequence set forth in SEQ ID NO: 9 orthe nucleotide sequence set forth in SEQ ID NO:
 8. 33. The compositionof any one of claims 24-32 that is formulated for intramuscularinjection or intravenous injection.
 34. The composition of any one ofclaims 24-34 that is formulation for systemic administration.
 35. Thecomposition of claim 34, wherein the systemic administration isparenteral administration by injection, infusion or implantation. 36.Use of the recombinant AAV vector of any one of claims 1-10 or thecomposition of claim 11 in the preparation of a medicament for reducingfibrosis in a mammalian subject in need thereof.
 37. Use of therecombinant AAV vector of any one of claims 1-10 or the composition ofclaim 11 in the preparation of a medicament for increasing muscularforce in a mammalian subject in need thereof.
 38. The use of claim 36 orclaim 37, wherein the subject is suffering from muscular dystrophy. 39.Use of the recombinant AAV vector of any one of claims 1-10 or thecomposition of claim 11 in the preparation of a medicament for treatingmuscular dystrophy in a mammalian subject.
 40. The use of claim 38 or39, wherein the muscular dystrophy is limb-girdle muscular dystrophy.41. The use of any one of claims 36-40, wherein the medicament furthercomprises a second recombinant AAV vector comprising the miR-29nucleotide sequence.
 42. Use of the recombinant AAV vector of any one ofclaims 1-10 or the composition of claim 11 in combination with a secondrecombinant AAV vector comprising a polynucleotide sequence comprisingmiR29C in the preparation of a medicament for reducing fibrosis in amammalian subject in need thereof.
 43. The use of claim 41 or 42,wherein the second recombinant vector comprises the nucleotide sequenceset forth in SEQ ID NO: 9 or the nucleotide sequence set forth in SEQ IDNO:
 8. 44. Use of the recombinant AAV vector of any one of claims 1-10of the composition of claim 11 in combination with a second recombinantAAV vector comprising a polynucleotide sequence comprising a miR-29c inthe preparation of a medicament for increasing muscular force in amammalian subject in need thereof.
 45. The use of claim 44, wherein thesecond recombinant vector comprises the nucleotide sequence set forth inSEQ ID NO: 9 or the nucleotide sequence set forth in SEQ ID NO:
 8. 46.The use of any one of claim 39-45, wherein the subject is suffering frommuscular dystrophy.
 47. Use of the recombinant AAV vector of any one ofclaims 1-10 of the composition of claim 11 in combination with a secondrecombinant AAV vector comprising a polynucleotide sequence comprising amiR-29c in the preparation of a medicament for treating musculardystrophy in a mammalian subject.
 48. The use of claim 47, wherein thesecond recombinant vector comprises the nucleotide sequence set forth inSEQ ID NO: 9 or the nucleotide sequence set forth in SEQ ID NO:
 8. 49.The use of claim 47 or 48, wherein the muscular dystrophy is limb-girdlemuscular dystrophy.